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Match Your Ankylosing Spondylitis Treatment to the Severity of Flares

Your AS flares may be telling you that it's time to increase treatment to protect your emotional as well as your physical health.

By Denise Mann

Medically Reviewed by Farrokh Sohrabi, MD

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Flares are par for the course when you live with back pain and stiffness associated with ankylosing spondylitis, but research has shown that frequent, severe flares may indicate a more active underlying condition that necessitates more aggressive treatment.

Ankylosing spondylitis, also called AS or spinal arthritis, is considered an autoimmune disease, which means that your immune system reacts against your own joints and tissues, causing low back pain, stiffness, and inflammation. Similar to other autoimmune diseases, it’s typical to experience AS flares followed by periods of remission, during which AS symptoms will abate. Scientists have found that the severity of ankylosing spondylitis varies greatly from person to person.

In one study of 134 people with AS, published in the journal Rheumatology, 70 percent of participants said they experienced a flare each week, but individual experiences showed that some people had a far greater degree of AS than others. Participants were asked about minor flares that affected one area and major flares or those that are marked by widespread pain, fever, and other symptoms. People who experienced major flares reported that the exacerbations build up gradually and last for more than two weeks. They also seemed to have a more severe level of underlying AS than those who experienced minor flareups.

AS Flares: What's Normal?

“A flare usually signifies a change in disease activity," said David Pisetsky, MD, chief of rheumatology at Duke University Medical Center in Durham, N.C. Flares vary in severity and are based on symptoms, and he said there's not an objective way to define or measure a "normal" AS flare. Some flares will require little more than extra non-steroidal anti-inflammatory drugs (NSAIDs), but other times, they may require a change or step up in treatment, such as the introduction of biologic drugs that target proteins involved in the inflammation cascade if a peron's AS worsens. Because these drugs have more severe side effects, they're usually prescribed only for those with a more severe disease.

“A flare per se does not mean a change in therapy,” Dr. Pisetsky said. “It depends on what kind of therapy a person is currently taking. We ask, ‘Is this flare a sustained change in disease activity that would prompt a change in therapy?’”

Eric L. Matteson, M.D, chairman of the division of rheumatology and a professor of medicine at Mayo Clinic in Rochester, Minn., agreed. “Flares can be mild, and you know they will pass with a little extra NSAIDs or steroids,” he said. “But if it lasts too long, you may need a change of treatment.” Experiencing long-lasting flares that impact your quality of life is a sign to talk to your doctor to discuss your options for more aggressive treatments, he suggested.

Depression: An AS Risk

Depression has been linked to frequent and severe ankylosing spondylitis — another reason why it's important to speak to your doctor if you're experiencing AS to this extent. A new study from the French Society of Rheumatology, which involved 200 people with AS, found that nearly two-thirds of the participants with high disease activity showed signs of severe depression. Adding the emotional toll of AS to its physical toll can put your health in a downward spiral.

When a Flare Is Not AS

Most people with AS know when they're having a flare, Dr. Matteson said. But, experience will help you distinguish a true AS flare from something that acts like a flare. For instance, back pain that causes weakness or numbness in a leg or that feels better when you rest is uncharacteristic of an AS flare; it’s more likely disc-related, said Matteson. In such an instance, it’s a good idea to see your doctor and find out precisely what's causing the pain and how best to treat it.






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Date: 10.12.2018, 15:31 / Views: 95433