Enteropathic Arthritis
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MEDICATION
Overview
There are a number of different types of medications that have been found to be effective in managing the symptoms of enteropathic arthritis. Unlike other forms of spondylitis, enteropathic arthritis may require the attention of a gastrointenologist as well in order to help treat the IBD component of the disease.
NOTE: Different people respond to different medications with varying levels of effectiveness. Thus, certain medications may work as well, depending on the individual. It may take time to find the most effective medication for treating someone with enteropathic arthritis.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
With most forms of arthritis and spondylitis, NSAIDs (non-steroidal anti-inflammatory drugs) are commonly used to help reduce the pain and stiffness in the joints. However, these medications are often not an option for some people with IBS because they can irritate the intestinal lining and actually intensify the inflammation.
A newer class of NSAIDs known as COX-2 inhibitors (or COXIBs) allegedly reduce the risk of gastrointestinal complications associated with traditional NSAID therapy. However, in recent months two of the COX-2 inhibitors have been found to have their own potential, serious side effects. One of the more regularly prescribed COX-2s, Vioxx (Rofeocoxib), was pulled from the worldwide market because of the possible increased risk of heart attack when taking the medication. Another COX-2, Bextra, was also pulled from the market in April of 2005.
***Position Statement from SAA's Medical and Scientific
Advisory Board on the COX-2 Inhibitors***
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Celebrex, Arcoxia, and Vioxx are examples of a class of drug known as
the COXIBS. It appears that all anti-inflammatory agents, COXIB and
non-COXIB, may have the potential to increase the risk of heart attacks,
heart failure, and strokes. Patients with past and/or current heart
disease, and those at serious risk of heart disease (e.g. diabetics),
should check with their physician before continuing to take any of these
medications
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Other less common side effects from NSAIDs include headaches, dizziness, fluid retention and even confusion.
Below are the names of the more commonly used NSAIDs in treating ankylosing spondylitis as well as links to more information on each drug.
Stay Informed!
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Stay up-to-date on all the latest news and information regarding AS and related diseases including medications with our news magazine, Spondylitis Plus. Your subscription comes free with SAA membership.
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Sulfasalazine
Sulfasalazine is one type of medication that can be helpful to some people with severe disease. It is known to effectively control not only pain and joint swelling from arthritis of the small joints, but also the intestinal lesions in inflammatory bowel disease. It comes in tablet form and is taken orally.
Side effects are relatively infrequent, but can include headaches, abdominal bloating, nausea and oral ulcers. Rarely, someone being prescribed this medication can develop bone marrow suppression, which is why it is important for your doctor to regularly monitor your blood count.
AZULFIDINE (Sulfasalazine)
Patient Information
Methotrexate
Originally developed to treat cancer, this chemotherapy drug is widely used and often very effective for the treatment of rheumatoid arthritis. When prescribed for treating enteropathic arthritis, it is given in much smaller doses. Methotrexate can either be taken via a self-injectable shot, or orally in tablet form. When taking methotrexate, it is also necessary to take the vitamin folic acid in order to help suppress possible side effects.
Oral ulcers and nausea are the most common side effects, but can be minimized by taking folic acid. Because of other potential serious side effects, the frequent monitoring of blood counts and liver tests are required. Click here for an article on methotrexate in the treatment of enteropathic arthritis, or click the link below for more information on the drug.
Corticosteroids
Corticosteroids such as prednisone can be effective in relieving the inflammation of enteropathic arthritis, but the side effects of long-term use can be very severe. Corticosteroid injections into the inflamed joints can provide temporary relief of the pain caused by arthritis or bursitis. In instances of Achilles' tendonitis, such injections are rarely, if ever used because of the risk of rupturing the Achilles tendon. Also, the usefulness of corticosteroid injections to relieve the symptoms of plantar fasciitis (heal pain) is not clear. More information on corticosteroids can be found at Medline Plus.
The Biologics: TNF Inhibitors
This class of medications has shown great promise in treating spondylitis and Remicade in particular has been approved by the FDA for treating Crohn's disease. They have been shown to be highly effective in treating not only the arthritis of the joints but also the spinal arthritis. Click here for more information in our Ongoing Special Report: The Biologics, TNF Inhibitors.
The most serious side effect of TNF blockers is an increased frequency of infections, especially tuberculosis. Thus, a TB test is ususally required before starting any of the TNF therapies. A very rare possible complication is increased frequency of cancer, especially of the blood (leukemia) or of the lymphatic system (lymphoma).
Note that not everyone with enteropathic arthritis will need these medications. You and your doctor can decide which of these medications, if any, would be best for you.
Click here for more information in our Ongoing Special Report: The Biologics, TNF Inhibitors.
Note that not everyone with enteropathic arthritis will need these medications. You and your doctor can decide which of these medications, if any, would be best for you.
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