30

Diclofenac
Paracetamol 400 mg Orphenadrine citrate 35 mg

U/D : Ankylosing Spondylitis (AS), Hypertension

VS : BP 129/87 mmHg, Pulse 101 bpm
PMH :

 Azathioprine 50 mg 1 x 1 pc morning
Methotrexate 2.5 mg 6 x 1 pc evening
Sulfasalazine 500 mg 3 x 2 pc
HCTZ 25 mg 1/2 x 1 pc morning
Enalapril 5 mg 1 x 2 pc
Pamidronate 60 mg IV drip OD q 28 day
Diclofenac 25 mg 1 tab prn
Paracetamol 500 mg 2 tab prn
Folic acid 5 mg 1 x 1 pc evening
 Exam Result Unit L/H Normal
RBC 4.22 M/cumm L 4.5 6.3
HB 13.3 g/dL N 13 - 17.4
Hct 41.1 % N 40 - 52
WBC 7,730 Cells/cumm N 4,600 10,200
Neutrophil 59.7 % N 37-80
Lymphocyte 29.3 % N 10-50
Monocyte 8.08 % N < 12
Eosinophil 1.96 % N <7
Basophil 0.975 % N < 2.5
Exam Result Unit L/H Normal

142,000
Platelet 371,000 Cells/cumm N 424,000

MCV 97.3 fL H 80 97

MCH 31.6 pg H 27 31.2

MCHC 32.4 g/dL N 31.8 35.4

RDW 13.6 % N 11.6 14.8

A B
 AS
Guideline for Management of Ankylosing
Spondylitis NSAIDs
by Thai Rheumatism association
Diclofenac
Azathioprine

guideline
Sulfasalazine AS
Methotrexate
DMARDs

Anti-TNF
 NSAIDs coxibs
AS 50

SSZ vs SSZ + MTX
Pamidronate
 : Indian spinal Injuries Centre Superspeciality Hospital :
ISIC-SH 46

(New York Criteria)

AS
peripheral arthritis
NSAIDs coxibs 3

anti-TNF agents
1 day 7 day 14 day 21 day 28 day

Oral MPP 12-16 mg 30 min MTX SC 10 mg
NSAIDs or coxibs prn up to 20-25 mg.
6 cycle
Calcium 1 g. daily
Vitamin D2 250 IU
Amitriptyline 10 mg.IV pulse infusion MPP 500 mg for 3 days
+ Pamidronate 60 mg. slow IV infusion

Oral SSZ 1 g. bid

Folic acid 5 mg.
 ASAS

Patient global Pain Function Inflammation

assessment

VAS global VAS pain BASFI BASDI

(0-100) (0-100) (0-100) (0-100)

Improvement of 20% (ASAS-20)

Absolute improvement of 10%
(on a scale of 0-100) in3 of the
following 4 domains
81%
 46

39 (84.78%) 7 (15.22%)


 cycle
- 24 (4 )
- (5 )
paracetamol

methylprednisolone
2



1. IV infusion

2.
anti-tumour necrosis factor-
 Azathioprine 50 mg 1 x 1 pc morning
Sulfasalazine 1 g 1 x 2 pc
HCTZ 25 mg 1/2 x 1 pc morning
Enalapril 5 mg 1 x 2 pc
Diclofenac 25 mg 1 tab prn
Paracetamol 500 mg 2 tab prn (fever,pain)
Folic acid 5 mg 1 x 1 pc evening
Pamidronate 60 mg IV drip OD q 28 day
 Methotrexate 20-25 mg sc q 7 days
Methylprednisolone 12-16 mg q 7 day
Methylprednisolone 500 mg IV pulse infusion
for 3 day q 28 day
Adjunct supportive medicines
Calcium 1 g. daily
Vitamin D2 250 IU daily
Amitriptyline 10 mg. daily
 Bath ankylosing spondylitis disease
activity score (BASDI)

Bath ankylosing spondylitis function

index (BASI)

Bath ankylosing spondylitis disease

metrology index (BASMI)
1.

2.

3.

4.

5.

6.

 1. /

2.

3.

4.

5.

 6. 10

7. 12-15 steps

8.

9. ( , , )

10.

 .. 2556 7 .. 2556
6.6 Drugs affecting bone metabolism