TREATMENT OF REFRACTORY SPONDYLOARTHROPAT HIES

Failure of antiinflammatory agents: Non-steroidal antiinflammatory dru gs are the mainstay of treatment in patients with spondyloarthropathy. in case of non-response the clinician should reassess dosage, search for HIV infection and question the diagnosis. Alternatives: infiltrati ons often provide improvement in case of localized lesions. Diffuse or severe lesions may benefit from bolus injections of methylprednisolon e. Second-line drugs: Prolonged or repeated episodes justify second-li ne drug treatment. Sulfapyridine can be prescribed as a first line dru g although the effect is variable. The efficacy of methotrexate remain s to be confirmed by controlled trials, Therapeutic decisions are part icularly difficult in patients with HIV infection a methotrexate has b een suspected of accelerating progression to AIDS.