Ankylosing spondylitis is a chronic inflammatory disease, which mainly invades sacroiliac joints, spinal apophysis, paravertebral soft tissues and peripheral joints, and seriously affects the quality of life of patients. Drug therapy is the key to control the development of the disease. The following is a discussion on the choice of drugs for its treatment.
Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for ankylosing spondylitis. These drugs, such as ibuprofen and diclofenac, can quickly reduce the pain and stiffness of patients. They inhibit the activity of cyclooxygenase in vivo and reduce the synthesis of prostaglandins, thus achieving anti-inflammatory, analgesic and antipyretic effects. For patients with early and mild symptoms, regular use of NSAIDs can effectively improve the symptoms of the spine or peripheral joints and improve the mobility of patients. However, the use of NSAIDs also has some problems, long-term or excessive use may cause gastrointestinal discomfort, including nausea, vomiting, ulcers, etc., and may also damage liver and kidney function, some patients will also have cardiovascular risks, so we need to pay close attention to adverse reactions in the use process.
Anti-rheumatic drugs (DMARDs) also play an important role in the treatment of ankylosing spondylitis. Sulfasalazine is a commonly used drug that can improve joint pain and swelling in patients, and has a good effect on some peripheral arthritis. Methotrexate can also be used for treatment, but its efficacy is not as significant in the treatment of ankylosing spondylitis as in rheumatoid arthritis. The use of these drugs need to pay attention to its side effects, sulfasalazine may cause blood system abnormalities, liver function damage, methotrexate may cause bone marrow suppression, oral mucosal damage, etc., during the use of drugs need to regularly check blood routine, liver and kidney function and other related indicators.
The emergence
of biologics has revolutionized the treatment of ankylosing spondylitis. Tumor necrosis factor-α (TNF-α) inhibitors are currently the most widely used biological agents, including etanercept, infliximab, adalimumab and so on. They can specifically block the activity of TNF-α, effectively control inflammation, alleviate the symptoms and signs of patients, improve joint function, and delay the progress of the disease on imaging. It is especially effective for patients with severe illness and poor response to traditional drug treatment. However, biological agents are not risk-free, they may increase the chance of infection in patients, especially tuberculosis, hepatitis B virus reactivation and so on, so strict screening of related infections is needed before use.
Glucocorticoids are generally not recommended for long-term oral use. In the acute stage of ankylosing spondylitis, especially when accompanied by severe inflammation of peripheral joints or acute iritis and other extra-articular manifestations, short-term small doses, such as prednisone, can be used. Its powerful anti-inflammatory effect can quickly relieve symptoms, but long-term use can bring many serious side effects, such as osteoporosis, central obesity, elevated blood sugar, increased risk of infection and so on.
In addition, for patients with ankylosing spondylitis with osteoporosis, anti-osteoporosis drugs such as calcium and vitamin D should also be used rationally, such as calcium carbonate and calcitriol, to prevent complications such as fracture. When choosing drugs for ankylosing spondylitis, doctors need to take into account the severity of the patient’s condition, age, gender, complications, efficacy and safety of drugs and other factors to develop personalized treatment programs for patients.
