Overview
Arthritis of the spine encompasses various inflammatory and degenerative conditions affecting the vertebral column, including ankylosing spondylitis, rheumatoid arthritis, and osteoarthritis, leading to pain, stiffness, and functional impairment 1.Diagnosis
Clinical evaluation focusing on history of joint pain, stiffness, and neurological symptoms 1.
Imaging studies such as X-rays, MRI, and CT scans to assess structural changes and inflammation 1.
Laboratory tests including ESR, CRP, and RF for inflammatory markers and autoimmune markers 1.Management
First-line treatments: Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation 1.
Disease-modifying antirheumatic drugs (DMARDs): For rheumatoid arthritis, methotrexate or other DMARDs to slow disease progression 1.
Biologics: TNF inhibitors or IL inhibitors for refractory cases, particularly in ankylosing spondylitis and rheumatoid arthritis 1.
Physical therapy: Regular exercises to maintain flexibility and strength 1.
Corticosteroids: Intra-articular injections or systemic use for acute exacerbations 1.Special Populations
Pregnancy: Limited direct evidence; cautious use of DMARDs and biologics, focusing on safety profiles; NSAIDs use should be minimized due to potential risks 1.
Elderly: Tailored treatment plans considering comorbidities and polypharmacy; emphasis on non-pharmacological interventions 1.
Comorbidities: Management strategies should account for coexisting conditions like cardiovascular disease or osteoporosis, adjusting drug choices accordingly 1.Key Recommendations
Utilize a comprehensive diagnostic approach combining clinical assessment, imaging, and laboratory tests for accurate diagnosis of spinal arthritis 1.
Initiate treatment with NSAIDs for symptomatic relief, escalating to DMARDs or biologics based on disease severity and response 1 (Evidence: Strong).
Implement physical therapy as a cornerstone of management to preserve function and mobility 1 (Evidence: Moderate).
Exercise caution with medication choices in pregnant women and elderly patients, prioritizing safety and efficacy 1 (Evidence: Expert opinion).
Ensure traceability of biological treatments through detailed exposure documentation to monitor adverse events effectively 2 (Evidence: Expert opinion).References
1 Kingston R, Sioris K, Gualtieri J, Brutlag A, Droege W, Osimitz TG. Post-market surveillance of consumer products: Framework for adverse event management. Regulatory toxicology and pharmacology : RTP 2021. link
2 Vermeer NS, Spierings I, Mantel-Teeuwisse AK, Straus SM, Giezen TJ, Leufkens HG et al.. Traceability of biologicals: present challenges in pharmacovigilance. Expert opinion on drug safety 2015. link
3 Klein K, De Bruin ML, Broekmans AW, Stolk P. Classification of Recombinant Biologics in the EU: Divergence Between National Pharmacovigilance Centers. BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy 2015. link