新人999脊柱炎如何治疗配图，仅供参考
How is it treated?New evidence based recommendations for the management of ankylosing spondylitis have been produced by the International Assessment in Ankylosing Spondylitis working group in collaboration with the European League Against Rheumatism.,# Physiotherapy
This is a key element of the overall management of all patients. A recent Cochrane review found evidence that physiotherapy had beneficial effects for patients with ankylosing spondylitis,but it was not clear which specific treatment protocol should be followed. Many patients find hydrotherapy particularly beneficial.w11
# Non-steroidal anti-inflammatory drugs
Randomised controlled trials have shown that,compared with placebo,NSAIDs improve spinal pain,peripheral joint pain,and function in ankylosing spondylitis. Cyclo-oxygenase-2 selective inhibitors and traditional NSAIDs seem broadly similar in efficacy. One study has suggested that regular use of NSAIDs,starting with celecoxib,inhibits radiographic progression in ankylosing spondylitis compared with NSAID use on demand,giving some support to the regular use of NSAIDs in active ankylosing spondylitis. The decision on which NSAID to use should be on an individual patient basis taking into account risk factors,particularly for gastrointestinal and cardiovascular disease. Analgesics,including paracetamol and opioids,may be considered when NSAIDs are contraindicated or not tolerated.
# Disease modifying antirheumatic drugs
Sulfasalazine has inconclusive evidence for efficacy in ankylosing spondylitis. A recent Cochrane review of 12 randomised controlled trials has found some evidence of benefit in peripheral joint symptoms and in reducing morning stiffness and erythrocyte sedimentation rate but no evidence of benefit in physical function,pain,spinal mobility,enthesitis,or patient or physician global assessment.
A Cochrane review of methotrexate for treating ankylosing spondylitis concluded that there was no evidence to support its use.w12 It included only two papers,however,and a subsequent small study of low dose methotrexate did suggest some clinical benefit in ankylosing spondylitis.w13 There is little evidence to support the use of other traditional disease modifying antirheumatic drugs in ankylosing spondylitis.w14
# Corticosteroids
Intra-articular or periarticular corticosteroid injections for sacroiliitis have been shown to be effective in small trials.w15 w16 Local corticosteroid injections for peripheral arthritis and enthesitis in ankylosing spondylitis are widely used in clinical practice to good effect,but no clinical trials exist to support this use. Intravenous methylprednisolone is occasionally used in severe unresponsive cases,but this use may decline with the availability of tumour necrosis factor inhibitors.
# Bisphosphonates
Oral bisphosphonates are commonly used for fracture prevention in ankylosing spondylitis.w17 Bisphosphonates also have an anti-inflammatory action and may have an effect on disease activity. Intravenous pulses of the bisphosphonate pamidronate have been investigated in several studies and have produced significant clinical improvements in some but not all studies.,w18 w19
# Cardiovascular risk
In common with other inflammatory rheumatic conditions,ankylosing spondylitis is associated with increased rates of cardiovascular morbidity and mortality.w20 This may be only partially explained by traditional risk factors,and it seems likely that the chronic inflammatory nature of the condition is partially responsible. Clinicians should be alert to this and take action to identify and treat traditional modifiable cardiovascular risk factors. It has been proposed that better control of the underlying inflammatory condition may improve this risk. It is also possible that chronic use of NSAIDs may increase this risk. As well as their effect on lipids,statins also have an anti-inflammatory effect,and a recent small open study has reported that rosuvastatin treatment produced clinical improvement in ankylosing spondylitis.w21
# Surgery
A large proportion of patients with ankylosing spondylitis develop hip arthritis. Hip replacement should be considered in patients with refractory pain or disability and with radiographic evidence of structural damage,independent of age. w22 w23 Spinal surgery may be of value in selected patients and is performed for a variety of reasons in ankylosing spondylitis patients,including fusion procedures for segmental instability and wedge lumbar osteotomy for fixed kyphotic deformity. Patients with severe ankylosing spondylitis present anaesthetic difficulties,and the risks and benefits of surgery need to be carefully considered.","department":"
