SPONDYLITIS.pptx

Spondylitis

1. Spondylitis N.Sowjanya, Pharm D III yr.

2. Definition “Spondylitis”, is an inflammatory disease disease of vertebrae vertebrae , in which it leads to partial or total fusion of the joints and bones of the spine.

3. Epidemology  ”Spondylitis” affects about 0.1% to  0.5% of the adult population. Although it can  occur at any age, spondylitis most often  strikes men in their teens and 20s. More common in some Native American tribes.

4. Etiology Although the cause of   Spondylitis  is  unknown,  there is a strong genetic or family link.   Most, but not all, people  with spondylitis carry a  gene called HLA- B27. . Although people carrying this gene are more  likely to develop spondylitis, it is also found in up to 10% of people who have no  signs of the condition. ly  link. Most, but not all, people with spondylitis carry a gene called HLA-B27. Although people carrying this gene are more likely to develop spondylitis, it  isalso  found in up to 10% of people who have no signs of the condition.

5. TYPES Cervical Spondylities :   pain that affects the cervical spin is called Cervical Spondylitis. Lumbar Spondylitis:  Pain in the lumbar region causes Lumbar Spondylitis.

6. Ankylosing spondylitis “Ankylosing spondylitis”, is a type of chronic arthritis of the spine and the sacroiliac joints. Affects the bones, muscles and ligaments cause severe pain and stiffness

7. PATHOGENESIS Immune-mediated. There is lively controversy regarding the primary site of disease initiation. The inflamed joints are infiltrated with CD4+ and CD8+ T cells and macrophages and shows high levels of TNF-α, Abundant TGF- α has been found in more advanced lesions.

8. It is characterized by neutrophils, macrophages expressing CD68 and CD163, CD4+ and CD8+ T cells, B cells , ICAM-1, VCAM-1, No specific event or exogenous agent that triggers the onset but reactive arthritis and inflammatory bowel disease (IBD) suggest that enteric bacteria may play a role. Elevated serum titers of antibodies to certain enteric bacteria but no role for these antibodies in the pathogenesis of AS B27 plays a direct role & develop spondylitis.

9. CLINICAL PRESENTATION Pain and stiffness c ontinue for more than three  months. around thesacroiliac  joints. Bony fusion O vergrowth of the bones,which  may lead to abnormal joining  of bones. Pain in ligaments  and tendon

10. Pain in the buttocks Arthritis Enthesitis Fatigue

11. FBC ESR CRP The rheumatologist may order the following tests: X-rays MRI Ultrasound DIAGNOSIS

12. TREATMENT

13. Physical and occupational  therapy: For good posture and a good range of spinal movement, the patient needs to be physically active. Exercise helps to prevent the spine from being stiff and causing pain. Yoga is very effective in treatment of Spondylitis

14. Surgery: Depending on the patient’s clinical situation two types. Joint Replacement surgery can allow people to regain the use of joints. Ostectomy A surgical procedure that involves cutting a section of bone in order to shorten or lengthen the bone itself.

15. MEDICATIONS Painkillers NSAIDS e.g. Aspirin (300-600 mg ,6-8 hrs daily). Ibuprofen ( 400-800mg BID) Naproxen ( 250mg) Selective CO II inhibitors: Celecoxib ( 100-200mg OD or twice) Roficoxib ( 12.5-25mg) They inhibit COX enzyme in the following pathway and relief the pain.

16. MOA OF NASAIDs: phospholipids Phospholipase A2 Arachidonic acid Cyclooxygenase lipooxygenase Prostaglandins Leucotriens Side effects: Gastritis PUD Increase in BP Increased risk of heart attack and stroke

17. Corticosteroids : Possible side effects include a ruptured tendon near the joint. e.g. Pridnisone(50-60mg oral) cortisone (25mg/ml inj) MO Steroid molecule bind to steroid receptors enter into nucleus Bind DNA

18. synthesis of specific mRNA cellular events occur SIDE EFFECTS PUD Avascular necrosis osteoporosis Renal toxicity

19. DMARDs (Disease-modifying anti-rheumatic drugs)   e.g. sulfasalazine dose: 2 g/day PO div bid MOA is not known. Methotrexate dose: 7.5-25 mg PO bid. MOA they inhibit folate reductase enzyme. Side effects Headache Nausea/vomiting Bone marrow suppression Liver toxicity

20. Biologics: Tumor necrosis factor (TNF) blockers e.g. Etanercept given as a weekly subcutaneous injection Remicade (Infliximab) given as a 2-hour IV infusion every 6 weeks Humira (Adalimumab) subcutaneous injection given twice a month. Simponi (Golimumab) subcutaneous injection given once a month to treat active ankylosing spondylitis.

21. MOA These drugs aim to reduce the amount of TNF (a protein in the body that triggers inflammation leading to the symptoms of ankylosing spondylitis) Side effects: Redness, Swelling, Itching, rash. occur at the injection site and typically last no more than 3 to 5 days.

22. Side effects: Side effects: Redness, Swelling, Itching, rash. occur at the injection site and typically last no more than 3 to 5 days.

23. Complications: Uveitis   Compression fractures   Inflamed aorta  ca rdiovascular disease   Breathing problems   Cauda equina syndrome

24. http://www.spondylitis.org/about/overview.aspx http://www.accesspharmacy.com/content.aspx?aID=2862756 http://www.spine-health.com/conditions/arthritis/ankylosing-spondylitis-symptoms http://basdai.com/ https://online.epocrates.com/noFrame/showPage.do?method=drugs&MonographId=284&ActiveSectionI http://www.spondylitis.org/about/as_treat.aspx https://online.epocrates.com/noFrame/showPage.do?method=drugs&MonographId=1186