How to treat seronegative spondyloarthropathies

Many of you may not have heard of this disease. Seronegative spondyloarthropathy is a chronic inflammatory rheumatic disease. Patients with this disease need timely treatment, otherwise it will pose a great threat to the health of the spine.

1. General treatment

1. Mission:

Patients should be educated on the disease so that they can understand the chronic course of the disease, the necessity of long-term treatment, and the possible adverse reactions during medication, and actively cooperate with the doctor's treatment.

2. Exercise and rest:

Except for rest during acute attacks or when important organs such as the heart and lungs are severely damaged, you should strengthen spinal and joint function exercises, do more chest expansion exercises to increase lung capacity, and sleep on a hard bed when resting.

3. Physical therapy:

It is beneficial for eliminating local inflammation, relieving pain and improving joint movement.

2. NSAIDs

NSAIDs can inhibit the inflammatory process and reduce joint pain, swelling and morning stiffness. Commonly used drugs include phenmethacin, diclofenac, naproxen, sulindac, etc.; phenmethacin should be taken in a sustained-release preparation, 1-2 mg/kg per day; phenylbutazone has definite efficacy, but because of its possibility of causing aplastic anemia, it is only used in stubborn cases. In the selection of NSAIDs, selective COX-2 inhibitors are currently preferred to reduce the toxic side effects of this type of drug on the gastrointestinal tract and kidneys.

3. Glucocorticoids

Systemic corticosteroids are rarely needed for SpA but can be used as intra-articular injections or, in acute iridocyclitis, as eye drops or subconjunctival injections. When muscle leg enthesis inflammation occurs, local injection can be performed. Only a small number of patients with severe disease or severe internal organ involvement, as well as those who are allergic to NSAIDs or cannot control their symptoms, may need low-dose corticosteroid treatment. Generally, the LOM expansion is less than 2 days. Some patients may need a larger dose or even shock treatment.

4. Disease-modifying medications

DMARDs can be used for chronic patients or those who fail to respond to NSAIDs. Commonly used preparations are sulfasalazine, 2-4g/day, or methotrexate (MTX) 7-15mg per week, but it will take 2-6 months to be effective. SASP is effective for peripheral joint and enthesis inflammation, but its efficacy for spinal lesions is uncertain. MTX is effective for many SpA patients, especially those with psoriatic arthritis who also have skin and joint lesions. However, large doses and long-term use of the drug can easily cause liver damage, which limits its use. If the above drugs are ineffective, azathioprine (AZA) can be used, 1-2 mg/kg per day. In addition, gold preparations, antimalarial drugs, cyclosporine, etc. all have certain therapeutic effects.

5. Chinese medicine Tripterygium wilfordii

It has achieved good results in the treatment of SLE and rheumatoid arthritis, and can also be used to treat SpA. The usual dose is 20 mg tid, which is changed to 10 mg Lid for maintenance treatment after symptoms improve. Attention should be paid to the toxic effects of this drug on the gonads, hematopoietic system, liver, and kidneys.