Ankylosing Spondylitis



Particularly involves the sacroiliac joints and the spine.

Sx:

Exam:

Dx:

Tx:

Acute:
Adults with pain and/or stiffness
  • NSAIDs
    • naproxen : adults: 500 mg orally twice daily, maximum 1250 mg/day
      ibuprofen : adults: 400-800 mg orally three times daily, maximum 3200 mg/day
      celecoxib : adults: 100 mg orally twice daily, maximum 400 mg/day
  • Analgesics
    • with local intra-articular inflammation or enthesitis
      • intra-articular corticosteroid injection
        hydrocortisone : 5-50 mg intra-articularly as a single dose
    • with peripheral joint involvement
      • sulfasalazine : 500 mg orally qd x1 week, then 500 mg BID x1 week, then 1000 mg QAM and 500 mg QHS for 1 week, then 1000 mg BID
Adults without pain and/or stiffness
  • Reassessment and observation
Children
with oligoarthritis:
  • NSAIDs
    • Naproxen : 5 mg/kg orally BID, max 1000 mg/day
    • Ibuprofen : 10 mg/kg orally q 6 h, max 40 mg/kg/day
  • intra-articular corticosteroid injection
    • Consult specialist

with polyarthritis:

  • Sulfasalazine :
    • > 6 years of age: 10 mg/kg/day orally given in 2 divided doses initially, increase gradually according to response, maximum 50 mg/kg/day given in 2-4 divided doses

with enthesitis and/or peripheral arthritis:

  • TNF-alpha inhibitor + nonpharmacologic measures
    • etanercept : consult specialist for guidance on pediatric dose
    • infliximab : consult specialist for guidance on pediatric dose
Ongoing:
  • adults with pain and/or stiffness refractory to 2 NSAIDs and nonpharmacologic measures
    • TNF-alpha inhibitor + physical therapy
    • continued NSAIDs
    • intravenous pamidronate + physical therapy
    • continued NSAIDs