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Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1812
Ambulatorio ASL 12, Biella, Italia
A 46-year-old man diagnosed with ankylosing spondylitis at age 20 years had begun noticing symptoms about 2 years before receiving the diagnosis. His medical history was unremarkable for features of note, familial occurrence or associated conditions. NSAID therapy prescribed by his general practitioner brought symptom relief. Ankylosing spondylitis was diagnosed by a rheumatologist. HLA-B27 was detected on testing. The rheumatologist prescribed NSAIDs and cycles of steroids therapy. The patient did not return for control visits for several years. On the advice of his treating physician, the patient came to my rheumatology clinic; during this first visit, widespread stiffness and limited function associated with severe pain were observed. No clinical signs of peripheral or extra-joint involvement were noted. Plain films of the spine and pelvis disclosed nearly complete ankylosis of the spine and the sacroiliac joints. A combination of symptomatic treatment and therapy with salazopyrin (3 mg/die) produced an initial clinical response. Six months later, because of persistent pain and inflammation, therapy with etanercept s.c. (25 mg twice a week) was initiated and salazopyrin continued at a dose of 3 mg/die. At the subsequent control visit about 1 month later, the patient’s condition had improved remarkably, with a reduction in stiffness and pain. Presently, 1 year later, etanercept treatment continues to maintain its effectiveness, without the need for NSAIDS or steroid therapy and without side effects. This biological therapy has changed the natural history of ankylosing spondylitis, leading to a significant improvement in the patient’s quality of life.