Managing Ankylosing Spondylitis: Medication and Pain Relief Tips

Q: Managing Ankylosing Spondylitis: Medication and Pain Relief Tips

Hello, thank you for your question. <br>Here are my responses：<br>1. <br>Between Salazine and Celebrex, which has fewer side effects and is suitable for long-term use? Salazine needs to be taken long-term and consistently. <br>This medication addresses the root cause of the disea

Medication-related issues in ankylosing spondylitis?

Hello Doctor, I would like to ask you the following questions:
1.
Between Salazine and Celebrex, which one has fewer side effects and is more suitable for long-term use?
2.
I am currently taking two capsules of Celebrex a day, and I am only 21 this year.
Will I need to take it for a lifetime? If taken long-term, will it cause liver or kidney issues?
3.
My doctor previously mentioned that I could gradually switch to taking it once a day or alternating between once and twice a day, but I sometimes feel sudden pain.
Is this because the medication is not adequately controlling my symptoms?
4.
When I experience sudden pain, is it okay to use a heating pad? What temperature should I use? How many times a day and for how long each time? Additionally, do I need to use heat therapy regularly?
I apologize for the many questions, and I appreciate your answers and assistance!

Niming, 20~29 year old female. Ask Date: 2023/01/25

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1.
Between Salazine and Celebrex, which has fewer side effects and is suitable for long-term use? Salazine needs to be taken long-term and consistently.
This medication addresses the root cause of the disease rather than acting as an anti-inflammatory, so it does not provide pain relief but can reduce inflammation and control the disease fundamentally, thereby alleviating pain.
Because the onset of the drug's action is slow, once you stop taking it, it takes a longer time to restart its effects, so it should be taken regularly even when not in pain.
Celebrex is a newer generation anti-inflammatory and pain relief medication.
Although it is less harsh on the stomach, long-term use can burden kidney function, so once pain decreases, the dosage can be reduced or discontinued.
Celebrex has a quicker onset of action, providing rapid pain relief when pain resumes, which is different from Salazine.
2.
I am currently taking two Celebrex daily; I am only 21 this year.
Will I have to take it for life? Will long-term use lead to liver or kidney issues? As mentioned, you can adjust or discontinue the medication based on joint symptoms.
Long-term use may affect kidney function, and in some cases, it may also impact liver function, so your physician will continue to monitor your kidney and liver function.
3.
My doctor previously mentioned that I could gradually switch to taking it once a day or alternating between once and twice a day, but sometimes I feel sudden pain.
Is this because it cannot be suppressed? Joint pain can fluctuate based on physical condition, work stress, and exercise, so it is indeed possible to experience increased pain at times.
In such cases, you can resume taking the anti-inflammatory and pain relief medication.
4.
Can I apply heat when I suddenly experience severe pain? What temperature should I use for heat therapy? How many times a day and for how long each time? Should I use heat therapy regularly? For acute pain, if there is localized warmth, you can use cold compresses or ice packs; if there is no localized warmth, you can apply heat.
The heat should be at a temperature similar to that of warm bath water or one that your body can tolerate.
It is generally recommended to apply heat for about thirty minutes at a time, and the frequency and duration of heat therapy can be adjusted based on the severity of symptoms.
Regular exercise can also help reduce the frequency of joint pain episodes.
Occasional heat therapy is also acceptable.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2023/01/25

More Info

Managing Ankylosing Spondylitis (AS) can be challenging, especially for a young individual like yourself. It's great that you're seeking information about your treatment options and pain management strategies. Let's address your questions one by one.

1. Salazine vs. Celebrex: Salazine (sulfasalazine) and Celebrex (celecoxib) are both used to manage symptoms of ankylosing spondylitis, but they work in different ways. Salazine is a disease-modifying antirheumatic drug (DMARD) that can help reduce inflammation and slow disease progression. It may have gastrointestinal side effects and can affect liver function, but it is generally well-tolerated. Celebrex, on the other hand, is a non-steroidal anti-inflammatory drug (NSAID) that is effective for pain relief and inflammation. It is often preferred for its lower risk of gastrointestinal side effects compared to traditional NSAIDs. However, long-term use of Celebrex can lead to cardiovascular issues and potential kidney problems. Ultimately, the choice between the two should be made in consultation with your healthcare provider, considering your medical history and any other medications you may be taking.

2. Long-term Use of Celebrex: Taking Celebrex daily at your age is not uncommon for managing AS, but it’s essential to monitor for side effects. Long-term use of NSAIDs can lead to gastrointestinal issues, kidney damage, and cardiovascular risks. Regular check-ups with your doctor, including blood tests to monitor liver and kidney function, are crucial. If you experience any concerning symptoms, such as abdominal pain, changes in urination, or unusual fatigue, you should contact your healthcare provider immediately.

3. Fluctuating Pain Levels: It’s not unusual for individuals with AS to experience fluctuations in pain levels. This can be due to various factors, including physical activity, stress, or even weather changes. If you find that your pain increases when you reduce your medication, it may indicate that your current dosage is not adequately managing your symptoms. It’s essential to communicate these changes to your doctor, who may adjust your treatment plan accordingly.

4. Heat Therapy for Pain Relief: Heat therapy can be beneficial for managing pain during flare-ups. Applying heat can help relax muscles and improve blood flow to the affected areas. You can use a heating pad, hot water bottle, or warm towel. The temperature should be warm but not hot enough to cause burns—typically around 104°F to 113°F (40°C to 45°C) is effective. You can apply heat for about 15-20 minutes at a time, several times a day as needed. However, be cautious if you have any skin sensitivities or conditions that may be exacerbated by heat.

In addition to medication and heat therapy, consider incorporating regular physical activity and stretching into your routine. Gentle exercises, such as swimming or yoga, can help maintain flexibility and reduce stiffness. It's also essential to maintain a healthy lifestyle, including a balanced diet and adequate hydration.

Lastly, always consult with your healthcare provider before making any changes to your medication or treatment plan. They can provide personalized advice based on your specific situation and health needs. Managing ankylosing spondylitis is a long-term commitment, but with the right strategies and support, you can lead a fulfilling life.

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