Immunosuppressants
Immunosuppressants inhibit key factors in the immune system that are responsible for inflammatory responses.
Methotrexate (Trexall, Otrexup, Rasuvo)
Methotrexate has an unknown mechanism of action in AS; it may affect immune function by inhibiting dihydrofolate reductase, interfering with purine synthesis. Effects are observed in the 3-6 weeks following administration. Methotrexate ameliorates symptoms (eg, pain, swelling, stiffness) but there is no evidence that it induces remission. Adjust the dose gradually to obtain a satisfactory response.
Related Questions:
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This 15-year-old female patient presented with recent onset of right-sided low back pain. Plain radiography findings were normal.
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MRI of the same patient whose radiography findings were normal (previous image). She underwent further evaluation, including MRI. The MRI (short tau inversion recovery [STIR]) showed increased sinal intensity in the right sacroiliac joint, revealing sacroiliitis. Other laboratory study findings were essentially normal. The patient was started on indomethacin and rapidly improved.
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Patient with ankylosing spondylitis affecting cervical and upper thoracic spine. The patient's spine has been fused in flexed position.
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Posterior view of a patient with ankylosing spondylitis affecting cervical and upper thoracic spine. The patient's spine has been fused in a flexed position.
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Anteroposterior radiograph of spine of a patient with AS. Ossification of annulus fibrosus can be observed at multiple levels, which has led to fusion of spine with abnormal curvature.
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Anteroposterior radiograph of spine of a patient with AS.
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Anteroposterior (left) and lateral (right) radiographs of a patient with AS.
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Radiographs of hand (top) and arm (bottom) of a patient with peripheral involvement of AS. Fusion of joint spaces and deformity can be observed.
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Sagittal MRI of thoracolumbar spine of a patient with AS. Syndesmophytes and anterior corner lesions can be seen.
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Radiograph shows vertebral fracture in a patient with AS.
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This radiograph of the lumbar spine of a patient with end-stage AS shows bridging syndesmophytes, resulting in bamboo spine.
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This radiograph of the cervical spine of a patient with AS shows fusion of the vertebral bodies due to bridging syndesmophytes.
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ASAS Classification Criteria for Axial Spondyloarthropathy.
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ASAS Classification Criteria for Peripheral Spondyloarthropathy.
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Family of spondyloarthropathies and HLA-B27 associated diseases
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Bilateral symmetric sacroiliitis in a patient with AS showing blurring of the margins of the joints and pseudo-widening.
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Bilateral symmetric sacroiliitis in a patient with AS with narrowing and sclerosis of the joints.
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Bilateral sacroiliac joint fusion in a patient with AS.
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Enthesitis at the site of the insertion of the annulus fibrosis on the corners of the vertebral bodies, shiny corner (Romanus) lesions.
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CT scan of the pelvis in a patient with AS showing ankylosis of the sacroiliac joints.
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CT scan of the L-spine in a patient with AS showing bony syndesmophytes.
Tables
Lawrence H Brent, MD Associate Professor of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, American College of Rheumatology
Disclosure: Stock ownership for: Johnson & Johnson.
Anand Patel, MD Fellow, Department of Rheumatology, Temple University Hospital
Anand Patel, MD is a member of the following medical societies: American College of Rheumatology, Pennsylvania Rheumatology Society, Philadelphia Rheumatism Society
Disclosure: Nothing to disclose.
Ruchika Patel, MD Attending Physician, Division of Rheumatology, Einstein Medical Center
Ruchika Patel, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology, Philadelphia Rheumatism Society
Disclosure: Nothing to disclose.
Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa
Disclosure: Nothing to disclose.
Rajni Kalagate, MD Resident Physician, Department of Internal Medicine, Albert Einstein Medical Center
Rajni Kalagate, MD is a member of the following medical societies: American Academy of Pediatrics, Indian Medical Association
Disclosure: Nothing to disclose.
Jason C Eck, DO, MS Assistant Professor, Department of Orthopedics and Physical Rehabilitation, UMass Memorial Medical Center
Jason C Eck, DO, MS is a member of the following medical societies: American Osteopathic Academy of Orthopedics, American Osteopathic Association, International Society for the Study of the Lumbar Spine, and North American Spine Society
Disclosure: Medtronic Honoraria Speaking and teaching
Elliot Goldberg, MD Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine
Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology
Disclosure: Nothing to disclose.
Scott D Hodges, DO Consulting Surgeon, Department of Orthopedic Surgery, Center for Sports Medicine and Orthopedics
Scott D Hodges, DO is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Medical Association, American Osteopathic Association, American Spinal Injury Association, North American Spine Society, Southern Medical Association, Southern Orthopaedic Association, and Tennessee Medical Association
Disclosure: Medtronic Royalty Consulting; Biomet Spine Royalty Consulting
S Craig Humphreys, MD Orthopedic Spine Surgeon, Department of Orthopedic Surgery, Center for Sports Medicine and Orthopedics
S Craig Humphreys, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Spinal Injury Association, North American Spine Society, Southern Medical Association, Southern Orthopaedic Association, and Tennessee Medical Association
Disclosure: Nothing to disclose.
James F Kellam, MD Vice-Chair, Department of Orthopedic Surgery, Director of Orthopedic Trauma and Education, Carolinas Medical Center
James F Kellam, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.
Kristine M Lohr, MD, MS Professor, Department of Internal Medicine, Center for the Advancement of Women's Health and Division of Rheumatology, Director, Rheumatology Training Program, University of Kentucky College of Medicine
Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians and American College of Rheumatology
Disclosure: Nothing to disclose.
William O Shaffer, MD Professor, Vice-Chairman and Residency Program Director, Department of Orthopedic Surgery, University of Kentucky at Lexington
William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, International Society for the Study of the Lumbar Spine, Kentucky Medical Association, Kentucky Orthopaedic Society, North American Spine Society, Southern Medical Association, and Southern Orthopaedic Association
Disclosure: DePuySpine 1997-2007 (not presently) Royalty Consulting; DePuySpine 2002-2007 (closed) Grant/research funds SacroPelvic Instrumentation Biomechanical Study; DePuyBiologics 2005-2008 (closed) Grant/research funds Healos study just closed; DePuySpine 2009 Consulting fee Design of Offset Modification of Expedium
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment