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Tough Questions Your SpA Patients May Ask You - PART 1

November 10 2015 3:25 PM ET via RheumReports RheumReports

Dr. Robert Inman gave an excellent talk on SpA in an engaging format of questions and answers with case-based examples and supporting data. I'll try to summarize some of the pearls from this talk based on questions all of us have heard from our patients.

Question: How can my back pain be mechanical if I am B27 positive?

Remember that although B27 can be present in 90% of patients with AS, conversely only 2% of patients with B27 have AS. Mechanical back pain is far more common than inflammatory back pain in the general population even if they are B27 positive. Patients who read things on the internet often don't realize this.

Question: Do I really need to exercise?

Exercise and physiotherapy are more beneficial in AS than in most other rheumatic diseases. Published literature shows the benefits of physio and exercise. Patients often say exercise is hard work and makes them more tired. We've all heard it but realistic goals of home stretching, walking and use of fitness centres, are achievable for most patients. Having a physiotherapist in your clinic is a huge asset but online resources through www.spondylitis.org can help as well.

Question: Do I really need to take my NSAIDs every day?

There is a study suggesting that NSAIDs taken continuously possibly retard progression of MSASS scores in a subset of patients with high CRP. Yesterday, Dr. Joachim Sieper presented an RCT of continuous vs on-demand diclofenac that showed no reduction of progression. The jury is still out, but probably there is not enough evidence to support taking NSAIDs continuously.

Question: What are the risks of continuous NSAIDs with my heart condition?

We are well aware of the cardiovascular issues with NSAIDs especially etoricoxib, rofecoxib and diclofenac. Dr. Inman pointed out there are data that show vascular mortality in AS patients is higher than in non- AS patients, and standard NSAIDs may have a protective effect.

Maybe this will help us when the next AS patient arrives with difficult questions. Stay tuned for Part 2! Thank you, Dr. Inman!


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About the Author

Dr. Shelly Dunne
Dr. Shelly Dunne

Dr. Shelley Dunne is a graduate of Memorial University of Newfoundland School of Medicine. She completed her training in Internal Medicine and a fellowship in Rheumatology at the University of Toronto. She has been in private practice since 1998 and is currently a consulting rheumatologist at the Toronto East General Hospital.

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