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Aksial spondyloartritt, Bekhterev, behandling: Medikamenter

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Hensikten med medisiner i behandlingen av aksial spondyloartritt er hovedsakelig å lindre smertene. Førstevalget er såkalte NSAIDs, som demper betennelse (inflammasjon) og virker smertestillende.

Det finnes en rekke ulike NSAIDs. I behandlingen av aksial spondyloartritt er det særlig de medisinene som har langvarig effekt (lang halveringstid) som brukes. Ved å ta disse om kvelden, vil virkningen være god gjennom hele natten, og fortsatt ha effekt på stivheten og smertene neste morgen.

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Listen over mulige bivirkninger av NSAIDs er lang og viktig å kjenne til. De vanligste problemene er magesmerter, kvalme, oppkast, diaré, hodepine, svimmelhet, tretthet og synsforstyrrelser. NSAIDs kan også virke ugunstig på lever og nyrer. NSAIDs disponerer for magesår og alvorlige mageblødninger. Hos personer som bruker NSAIDs over lang tid, kan det være aktuelt å bruke syredempende medisin for å forhindre utvikling av magesår. Snakk med legen din om dette. 

Personer som har sår eller blødninger i magesekken, eller allergi mot noen av innholdsstoffene, skal ikke bruke NSAIDs. Personer med forstyrrelser i blodlevringen, hjerte-, lever- eller nyresykdommer må utvise forsiktighet, og bruk under svangerskapets siste tre måneder er frarådet.

Ved manglende effekt av ett NSAID anbefales det å skifte til et annet NSAID før du prøver en ny type medisin. I noen tilfeller kan det være aktuelt å sprøyte kortison inn i betente ledd eller sener. 

Nye typer legemidler, såkalte biologiske medisiner, har forbedret behandlingstilbudet til de som ikke oppnår tilfredsstillende effekt med NSAIDs. 
Behandling med biologiske medisiner er spesialist-behandling som forskrives av spesialister i revmatologiske sykdommer. 

Vil du vite mer

Dette dokumentet er basert på det profesjonelle dokumentet Aksial spondyloartritt . Referanselisten for dette dokumentet vises nedenfor

  1. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017 Jul 1;390(10089):73-84. Epub 2017 Jan 20. PMID: 28110981. PubMed
  2. Nasjonal veileder i revmatologi. Aksial spondyloartritt. Norsk revmatologisk forening. Sist oppdatert 17.02.2023. norskrevmatologi.no
  3. Taurog JD, Chhabra A, Colbert RA. Ankylosing Spondylitis and Axial Spondyloarthritis. N Engl J Med. 2016 Jun 30;374(26):2563-74. PMID: 27355535. PubMed
  4. Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2023;82(1):19-34. PubMed
  5. Magrey MN, Danve AS, Ermann J, Walsh JA. Recognizing Axial Spondyloarthritis: A Guide for Primary Care. Mayo Clin Proc. 2020;95(11):2499-2508. PMID: 32736944. PubMed
  6. Kerola AM, Rollefstad S, Kazemi A, et al. Psoriatic arthritis, axial spondyloarthritis and rheumatoid arthritis in Norway: nationwide prevalence and use of biologic agents. Scand J Rheumatol. 2023;52(1):42-50. PubMed
  7. Sternes PR, Brett L, Phipps J et al. Distinctive gut microbiomes of ankylosing spondylitis and inflammatory bowel disease patients suggest differing roles in pathogenesis and correlate with disease activity. Arthritis Res Ther. 2022 Jul 7;24(1):163. PMID: 35794662 PubMed
  8. Bittar M, Deodhar A. Axial Spondyloarthritis. A Review. JAMA 2024. pmid:39630439 PubMed
  9. Hauk L. Spondyloarthritis: NICE Releases Guidelines on Diagnosis and Treatment. Am Fam Physician. 2017 Nov 15;96(10):677-678. PMID: 29431390. PubMed
  10. NICE Guideline NG65. Spondyloarthritis in over 16s: diagnosis and management. National Institute for Health and Care Excellence. February 2017. www.nice.org.uk
  11. Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68: 777-83. doi: 10.1136/ard.2009.108233 DOI
  12. Stolwijk C, van Tubergen A, Castillo-Ortiz JD, Boonen A. Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Rheum Dis 2015; 74: 65. pmid:23999006 PubMed
  13. Terslev L, Naredo E, Iagnocco A, et al. Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise. Arthritis Care Res (Hoboken) 2014; 66:741. PubMed
  14. Regnaux JP, Davergne T, Palazzo C, et al. Exercise programmes for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD011321. DOI: 10.1002/14651858.CD011321.pub2. DOI
  15. van den Berg R, Baraliakos X, Braun J, et al. First update of the current evidence for the management of ankylosing spondylitis with non-pharmacological treatment and non-biologic drugs: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Rheumatology (Oxford) 2012; 51: 1388-96. PubMed
  16. Bindesbøll C, Garrido-Cumbrera M, Bakland G, Dagfinrud H. Obesity Increases Disease Activity of Norwegian Patients with Axial Spondyloarthritis: Results from the European Map of Axial Spondyloarthritis Survey. Curr Rheumatol Rep. 2020 Jun 23;22(8):43. PMID: 32577833 PubMed
  17. Wendling D, Prati C. Smoking and spondyloarthritis: a bad connection. Rheumatol Int. 2015;35(12):1951-1953. PMID:26462673.
  18. Kroon FPB, van der Burg LRA, Ramiro S, Landewé RBM, Buchbinder R, Falzon L, van der Heijde D. Non-steroidal anti-inflammatory drugs (NSAIDs) for axial spondyloarthritis (ankylosing spondylitis and non-radiographic axial spondyloarthritis). Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD010952. DOI: 10.1002/14651858.CD010952.pub2 DOI
  19. Fragoulis GE, Siebert S. Treatment strategies in axial spondyloarthritis: what, when and how? Rheumatology (Oxford). 2020 Oct 1;59(Suppl4):iv79-iv89. PMID: 33053192 PubMed
  20. Maxwell LJ, Zochling J, Boonen A et al. TNF-alpha inhibitors for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD005468. DOI: 10.1002/14651858.CD005468.pub2 DOI
  21. Koo BS, Oh JS, Park SY et al. Tumour necrosis factor inhibitors slow radiographic progression in patients with ankylosing spondylitis: 18-year real-world evidence. Ann Rheum Dis. 2020 Oct;79(10):1327-1332. Epub 2020 Jul 13. PMID: 32660979. PubMed
  22. Hellgren K, Dreyer L, Arkema EV, et al. Cancer risk in patients with spondyloarthritis treated with TNF inhibitors: a collaborative study from the ARTIS and DANBIO registers. Ann Rheum Dis 2016. PMID: 27147709 PubMed
  23. Baeten D, Baraliakos X, Braun J et al. Anti-interleukin-17A monoclonal antibody secukinumab in treatment of ankylosing spondylitis: a randomised, double-blind, placebo-controlled trial. Lancet 2013; 382: 1705-13. pmid:24035250 PubMed
  24. Baeten D, Sieper J, Braun J, Baraliakos X, Dougados M, Emery P, Deodhar A, Porter B, Martin R, Andersson M, Mpofu S, Richards HB; MEASURE 1 Study Group; MEASURE 2 Study Group. Secukinumab, an Interleukin-17A Inhibitor, in Ankylosing Spondylitis. N Engl J Med 2015; 373: 2534-48. pmid:26699169 PubMed
  25. van der Heijde D, Wei JC-C, Dougados M, et al. Ixekizumab, an interleukin-17A antagonist in the treatment of ankylosing spondylitis or radiographic axial spondyloarthritis in patients previously untreated with biological disease-modifying anti-rheumatic drugs (COAST-V): 16 week results of a phase 3 randomised, double-blind, active-controlled and placebo-controlled trial. Lancet 2018. pmid:30360964 PubMed
  26. van der Heijde D, Baraliakos X, Gensler LS, et al. Efficacy and safety of filgotinib, a selective Janus kinase 1 inhibitor, in patients with active ankylosing spondylitis (TORTUGA): results from a randomised, placebo-controlled, phase 2 trial. Lancet 2018. doi:10.1016/S0140-6736(18)32463-2 DOI
  27. van der Heijde D, Baraliakos X, Sieper J, et al. Efficacy and safety of upadacitinib for active ankylosing spondylitis refractory to biological therapy: a double-blind, randomised, placebo-controlled phase 3 trial. Ann Rheum Dis. 2022. PMID: 35788492 PubMed
  28. Bakland G, Gran JT, Becker-Merok A et al. Work disability in patients with ankylosing spondylitis in Norway. J Rheumatol. 2011 Mar;38(3):479-84. Epub 2011 Feb 1. PMID: 21285159.
  29. Haroon N. Patients with ankylosing spondylitis have increased cardiovascular and cerebrovascular mortality: A Population-based Study. Ann Intern Med 2015; 163: 409-16. doi: 10.7326/M14-2470 DOI
  30. Exarchou S, Lindström U, Askling J, et al. The prevalence of clinically diagnosed ankylosing spondylitis and its clinical manifestations: a nationwide register study. Arthritis Res Ther. 2015;17(1):118. Published 2015 May 9. PMID: 25956915 PubMed
  31. Navarro-Compán V, Sepriano A, El-Zorkany B, van der Heijde D. Axial spondyloarthritis. Ann Rheum Dis. 2021;80(12):1511-1521. PubMed
  32. Scott IC, Whittle R, Bailey J, et al. Rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis epidemiology in England from 2004 to 2020: An observational study using primary care electronic health record data. Lancet Reg Health Eur 2022. pmid:36246147 PubMed
  33. Sieper J, van der Heijde D. Review: Nonradiographic axial spondyloarthritis: new definition of an old disease?. Arthritis Rheum. 2013;65(3):543-551. PubMed
  34. Hamilton L, Macgregor A, Warmington V, Pinch E, Gaffney K. The prevalence of inflammatory back pain in a UK primary care population. Rheumatology (Oxford). 2014 Jan;53(1):161-4. Epub 2013 Oct 17. PMID: 24136063. PubMed
  35. Chen J, Lin S, Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD004800. DOI: 10.1002/14651858.CD004800.pub3 DOI
  36. Chen J, Veras MMS, Liu C, Lin J. Methotrexate for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD004524. DOI: 10.1002/14651858.CD004524.pub4. DOI
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