Undifferentiated Spondyloarthropathy (USpA)
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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 Undifferentiated Spondyloarthropathy.
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 USpA.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are the most commonly used class of medication used in treating the pain and stiffness associated with USpA. For example, Ibuprofen is a generic NSAID and is found in over-the-counter pain relievers such as Advil and Motrin. They commonly come in tablet form and are taken orally.
Sometimes high doses of NSAIDs are needed to maintain relief from the symptoms of USpA. This can pose a problem in that NSAIDs can cause significant side effects, especially in the gastrointestinal tract (stomach, intestines, etc.) NSAIDs can cause reduction in the protective mucus in the stomach, which can cause stomach irritation. In time, this can lead to heartburn, gastritis as well as ulcers and even bleeding. People can take other medications to neutralize or prevent the production of excess stomach acid to help prevent these side effects (such as antacids), take drugs to help coat and protect the stomach (such as Carafate), or take medication to help restore the lost mucus (such as Cytotec).
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.
When NSAIDs Are Not Enough?
Although NSAIDs are commonly the first line of medications used to treat Undifferentiated Spondyloarthropathy, sometimes they aren't enough to control the symptoms. It is important to note, however, that it may take several weeks for some NSAIDs to show positive results. If you are considering changing medications, remember to ask your doctor about the potential benefits and side effects before you and your doctor decided whether the change in treatment is right for you.
In severe cases of USpA, NSAIDs may only be partially effective or the side effects to severe to continue their use. In this case, a doctor may prescribe one of the following medications.
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
Corticosteroids
Corticosteroids such as prednisone can be effective in relieving the inflammation of USpA, 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 ankylosing spondylitis and are sometimes prescribed off-label for USpA - specifically incases of severe 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 Undifferentiated Spondyloarthropathy 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 USpA 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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