CHARACTERISTICS OF ADMINISTRATION OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS IN ANKYLOSING SPONDYLITIS: CLINICAL OBSERVATION

Abstract

The study objective is to demonstrate characteristics of prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) for ankylosing spondylitis (AS) through a clinical case. Materials and methods . Male patient N., 34 years old, sought medical help complaining of pain in the cervical, thoracic, and lumbar spine, predominantly at night, at rest; limited range of motion in cervical and lumbar spine, pain in the area of external thigh surface, morning tightness longer than 2 hours. Stomachache after eating was also a complaint. The first episode of inflammatory pain was 10 years ago. Diagnosis of AS was determined 2 years ago, NSAIDs were prescribed which the patient didn’t take regularly. Based on clinical and laboratory examination, the following diagnosis was made. Main disorder: ankylosing spondylitis, late stage, stage III bilateral sacroiliitis, frontal spondylitis, high activity (BASDAI 5, 7, ASDAS-CRP 2, 7), HLA-В27-associated, with extra-articular manifestations (stage II bilateral coxitis, tendinitis of the shoulder rotator cuff muscle – superspinatus, supraspinatus, teres minor muscle, trochanteritis on both sides). Secondary diagnosis: NSAID-gastropathy, gastroesophageal reflux disease with esophagitis, gastroduodenitis associated with H. pylori. Meloxicam 15 mg/day in constant continuous regimen, methotrexate 12.5 mg SC once a week, folic acid 1 mg 5 days a week, sirdalud 4 mg 2 times a day, H. Pylori eradication therapy, glucocorticoid administration in the area of inflamed entheses were prescribed. Results . During the patient’s visit a month later, significant positive dynamics were observed: decreased pain in the lumbar, cervical, and thoracic spine, decreased pain in the shoulder joints, pain relief in the area of the greater trochanters, full active and passive range of motion in the shoulder joints. Duration of morning tightness was 1.5 hours. No complaints of pain in the epigastric region. In blood test: clinical and biochemical characteristics without abnormalities, С-reactive protein decreased from 62.5 to 20 mg/l. BASDAI 4, 3, ASDAS-CRP 2.0. Treatment with NSAIDs, methotrexate, proton pump inhibitor, folic acid was continued. Conclusion. NSAIDs are leading drugs for treatment of AS. Their prescription allows to relieve spinal pain and tightness, decreases enthesitis manifestations, exudative changes in the joints, allows to prevent or slow down structural changes in the spine. A very important treatment aspect is providing patients with information on the necessity of long-term continuous administration of NSAIDs and basic drugs, as well as on possible adverse events, regular laboratory control, necessity of gastroprotective drugs. Effectiveness of meloxicam in AS therapy was proved in a number of multicenter studies with a large number of patients. Meloxicam’s effectiveness is comparable to traditional NSAIDs – the “golden standard” (diclofenac, piroxicam, naproxem), but it’s more safe.