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Feature Article

The diagnosis and management of ankylosing spondylitis

David Langsford, Jane Zochling

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Abstract

Ankylosing spondylitis is a progressive rheumatological disease that is difficult to diagnose early and even more difficult to treat. The classic treatments of physiotherapy and NSAIDs have now been joined by the newer tumour necrosis factor-alpha inhibitors.

Key Points

  • Inflammatory back pain accounts for 5% of cases of chronic back pain.
  • Fifty percent of inflammatory back pain is due to ankylosing spondylitis (AS).
  • Early diagnosis of AS is important: the earlier it is treated the better the outcome in terms of pain, overall function and quality of life.
  • Before referral of patients to a rheumatologist useful information is gained by the GP from: x-rays of the pelvis and lumbar spine; measurement of erythrocyte sedimentation rate, C-reactive protein and HLA-B27; and a patient’s response to NSAIDs.
  • Most patients will respond to treatment with NSAIDs and physiotherapy.
  • Tumour necrosis factor (TNF)-alpha inhibitors are emerging as the most important therapy for severe AS; however, they are not without their adverse effects and significant cost.
  • Patients with long-established AS should be reviewed by a rheumatologist because treatment with TNF–alpha inhibitors in such cases can reduce morbidity.

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