How to Optimize the Use of Meloxicam for Ankylosing Spondylitis?

Q: How to Optimize the Use of Meloxicam for Ankylosing Spondylitis?

Hello, thank you for your question. <br>Here are my responses：<br>1) Can I just take Meloxicam when I have pain (and continue taking Celecoxib daily)? I'm worried that not taking Meloxicam every day and only taking Celecoxib might cause my previously well-controlled CRP levels to

How should Wan Ke Shi be taken for optimal results?

Hello, Doctor Gao.
I am a patient with ankylosing spondylitis.
For the past six months, I have been taking two Salazopyrin (Salsalate) tablets and one Voltaren (Diclofenac) tablet daily for treatment.
My CRP levels have been between 0.2 and 0.6, and my pain occurs approximately every two months for about 5-6 days (the pain situation is much better than before treatment, when my CRP was 1.5).
I have noticed that during these 5-6 days of pain, it tends to be concentrated every two months.
Therefore, I would like to ask the doctor:
1) Can I switch to taking Voltaren only when I experience pain (while continuing Salazopyrin), or am I concerned that not taking Voltaren daily and only taking Salazopyrin might cause my previously well-controlled CRP levels to rise significantly?
2) If I take Voltaren every day but only experience pain for an average of 5-6 days every two months, is it unnecessary to take Voltaren on the pain-free days? Since Voltaren is just a pain reliever, it seems reasonable to think that I don't need to take it when I'm not in pain.
Is this perspective correct? Thank you, Doctor.

Shao, 20~29 year old female. Ask Date: 2023/03/20

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1) Can I just take Meloxicam when I have pain (and continue taking Celecoxib daily)? I'm worried that not taking Meloxicam every day and only taking Celecoxib might cause my previously well-controlled CRP levels to rise significantly.
--> You can take Meloxicam during pain episodes.
It is important to continue taking Celecoxib daily, as its effects require consistent use.
Meloxicam primarily controls symptoms and acts quickly; even if pain recurs after stopping, taking it will provide rapid relief, and it does not affect CRP levels, so you can stop it and take it as needed.
2) I take Meloxicam every day, but I only experience pain for about 5-6 days every two months.
Is it unnecessary to take Meloxicam on pain-free days since it is just a pain reliever? Is this perspective correct? --> It is possible that while taking Meloxicam, your symptoms are more stable, and only during those 5-6 days does the arthritis exceed the control of the medication.
Even with regular medication, the disease can occasionally flare up.
If you want more stable symptoms, I recommend that in addition to medication, you also engage in more physical activity to see if you can reduce the occurrence of those 5-6 days of worsening symptoms.
Of course, you can also try stopping Meloxicam to see how it goes, as mentioned in the first question.

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

Reply Date: 2023/03/20

More Info

When managing ankylosing spondylitis (AS), optimizing the use of medications like meloxicam (a non-steroidal anti-inflammatory drug, or NSAID) is crucial for both pain relief and minimizing potential side effects. Based on your situation, here are some insights and recommendations:
1. Understanding Meloxicam and Its Role: Meloxicam is effective in reducing inflammation and pain associated with AS. It works by inhibiting cyclooxygenase (COX) enzymes, which play a key role in the inflammatory process. Regular use can help maintain lower levels of inflammation, as indicated by your C-reactive protein (CRP) levels, which have improved since starting treatment.

2. Adjusting Dosage Based on Symptoms: You mentioned that you experience pain for about 5-6 days every two months. It is reasonable to consider adjusting your medication regimen based on your symptoms. However, it’s essential to consult with your healthcare provider before making any changes. If you decide to take meloxicam only during flare-ups, ensure that you have a plan in place to monitor your symptoms and CRP levels.
3. Concerns About CRP Levels: Your concern about CRP levels rising if you stop taking meloxicam daily is valid. CRP is a marker of inflammation, and while you may not experience pain every day, inflammation can still be present. Regular use of meloxicam may help keep CRP levels in check, potentially preventing future flare-ups. Discuss with your doctor whether a lower, maintenance dose of meloxicam could be appropriate for you, rather than stopping it entirely.

4. Using Meloxicam as Needed: If you choose to take meloxicam only during painful episodes, be aware that it may take some time for the medication to exert its full effect. Therefore, starting meloxicam at the onset of pain may not provide immediate relief. Your idea of continuing to take meloxicam during flare-ups while maintaining a daily regimen of celecoxib (撒樂) is a common approach, as celecoxib is also an effective NSAID with a different side effect profile.

5. Evaluating the Need for Daily Medication: Your understanding that meloxicam is primarily for pain relief is correct. However, in chronic inflammatory conditions like AS, maintaining a baseline level of anti-inflammatory medication can help prevent the recurrence of symptoms. If you are experiencing significant periods without pain, it may be reasonable to discuss with your physician the possibility of tapering down your medication.

6. Monitoring and Follow-Up: Regular follow-up with your healthcare provider is essential. They can help monitor your CRP levels and overall disease activity, adjusting your treatment plan as necessary. If you notice any changes in your symptoms or CRP levels, report these to your doctor promptly.

7. Lifestyle Considerations: In addition to medication, consider incorporating physical therapy, exercise, and lifestyle modifications that can help manage AS symptoms. Regular physical activity can improve flexibility and reduce stiffness, which is beneficial for overall management of the condition.

In summary, while it is possible to adjust your meloxicam regimen based on your symptoms, it is crucial to do so under the guidance of your healthcare provider. They can help you find the right balance between managing pain and maintaining control over inflammation, ensuring that your treatment plan is tailored to your specific needs.

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