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Re: ankylosing spondylitis and ...From: Arthurfree@aol.comSat Apr 27 23:39:35 1996
Your lady is on a fairly extraordinary chronic dose of Prednisone. The combination of that and NSAIDS puts her at very high risk of active ulcer disease. Were you able to get her tapered, her dyspepsia would likely improve, and her hypertension would almost certainly improve. Smoking + surgical menopause + prednisone does put her at extremely high risk of osteoporosis, but of her risk factors, the prednisone dose is by far the most significant. In my experience, nothing is of much help in ankylosing spondylitis, and I would want strong affirmation by the patient that the prednisone is making a significant difference in order to keep her on it. NSAIDS do virtually nothing for AS. You cannot do anything that will help the patient quit smoking except education unless *she is ready to quit*, then there is a great deal you can offer in terms of strategy, support, and even pharmacologic support if necessary. Certainly remind her at each opportunity that the cigarettes raise her risks significantly and that you can help if she is ready to quit. Arthur Freeland, MD Centerville, Iowa
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