A study from the University of Alberta in Canada shows that intravenous infusion of pamidronate, a common drug for strengthening bones, helps to control ankylosing spondylitis, which is rheumatoid arthritis of the spine.

Ankylosing spondylitis is characterized by horrible back pain, point tenderness of the sacroiliac joints where the pelvis attaches to the spine, a rigid back that doesn’t bend when you do, and a positive blood test called HLA-B27. Severe cases are treated with potent drugs that suppress immunity and even cause death. Pamidronate is a drug that is used to treat osteoporosis and is safer than most of the drugs used to treat ankylosing spondylitis. The doctor puts around 60 mg of Pamidronate into 500 cc of fluid and runs it into the veins slowly over 4 to 6 hours. When this is done once a week for several weeks, the pains of ankylosing spondylitis often goes away.

The safest standard drugs used today to modify this disease is Sulfasalazine (Azulfidine) . Side effects can include headaches, abdominal bloating, nausea and oral ulcers. Rarely, someone being prescribed this medication can develop bone marrow suppression, so it is important for your doctor to regularly monitor your blood count when you take it. Another drug used to treat this disease is the more-toxic Methotrexate. Side effects include bone marrow suppression, with lowering of the blood counts, oral ulcers, nausea, gastritis or peptic laceration and liver toxicity. Use of this medication requires frequent monitoring of the blood counts and liver profile. Folic acid is often prescribed to treat the thinning hair and mouth ulcers associated with Methotrexate. Recently, doctors started prescribing the antibiotic, Minocycline, but this is not an accepted treatment, although it is very safe. It occasionally causing burning in the esophagus if it does not go into the stomach.

Doctors also prescribe corticosteroids, such as prednisone, but the side effects of long-term use are dangerous, (weight gain, osteoporosis, high blood pressure, diabetes, and so forth). Recently, the US Food and Drug Administration (FDA), approved new classes of second-line therapies called biological agents for some forms of arthritis. These new medications, called TNF-alpha antagonists, are increasing being prescribed for AS, and have shown excellent results in some people, but some people have died from their side effects. See report #J103.

A six-month randomized, controlled, double-blind, dose-response comparison of intravenous pamidronate (60 mg versus 10 mg) in the treatment of nonsteroidal antiinflammatory drug-refractory ankylosing spondylitis. Arthritis and Rheumatism, 2002, Vol 46, Iss 3, pp 766-773. WP Maksymowych, GS Jhangri, AA Fitzgerald, S LeClercq, P Chiu, A Yan, KJ Skeith, SL Aaron, J Homik, P Davis, D Sholter, AS Russell. Maksymowych WP, Univ Alberta, 562 Heritage Med Res Bldg, Edmonton, AB T6G 2S2, CANADA

Checked 9/3/05