Management Strategies for Rheumatic Disorders
In this article, a group of rheumatic diseases affecting the tendons and joints are reviewed. This group of chronic inflammatory diseases are called spondyloarthropathies (SpA). SpA include ankylosing spondylitis (AS),psoriatic arthritis (PsA), and reactive arthritis (ReA).
Since arthritis can occur in up to 30 per cent of patients with inflammatory bowel disease (IBD), this group is included in the spondyloarthropathies as well. This is referred to as enteric arthritis. Signs and symptoms and lab values for each of the SpAs are described.
X-rays and other imaging studies are helpful in making the diagnosis. Total body MRI scans only take 30 minutes and can show all areas affected. The authors present specific radiographic findings for AS. Certain features and deformities typical of each particular spondyloarthropathy help make the diagosis. For example, a destructive pencil-in-cup deformity may be seen with PsA. The end of the affected bone becomes pointed while the opposite joint surface becomes shaped like a cup.
Management of the SpAs begins with patient education. Individuals affected by the SpAs must take their home program seriously for the best results. Making choices to stop smoking and exercise daily are strongly encouraged. Physical therapy to address issues of posture, self-care, breathing, and strength training is advised. Patients who understand the need to follow their doctor and therapist's suggestions may have the best outcomes.
Drug treatment begins with a nonsteroidal anti-inflammatory (NSAID). Osteoarthritis is a common problem for patients with SpA and must be treated as well. For patients whose disease does not respond to therapy, tumor necrosis factor-alpha inhibitors (TNF-a inhibitors) may be used. These biologic agents include infliximab, adalimumab, and etanercept.
When and how to use these TNF-a inhibitors can be difficult to decide. The authors provide a detailed table of diagnosis, dosing, and expected results for drug treatment. If one TNF-a inhibitor doesn't work, another can be tried.
These drugs must be used on a long-term basis, but they are expensive. They also have some serious side effects. The most common problems are allergic reactions and an increased number of infections. Patients with a past history of tuberculosis (TB) may be at risk for reactivation of the TB.
Each patient will require a unique management program. Treatment depends on the underlying disease and current symptoms. Surgery is an option for some patients. Referral to a specialist is needed from time to time for patients with skin (psoriasis), eye (uveitis),or other problems.
Mazen Elyan, MD, and Muhammad Asim Khan, MD. Update On the Spondyloarthropathies. In The Journal of Musculoskeletal Medicine. January 2008. Vol. 25. No. 1. Pp. 31-40.
*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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