Spondyloarthritis (SpA) are a group of chronic inflammatory rheumatic diseases that affects the spine. Axial SpA is a subtype of the disease that primarily involves joints, tendons and bones around the pelvis. SpA is predominantly a genetically determined condition that has a strong association with a type of gene called HLA B27. The term non-radiographic axial SpA refers to a new group of diseases that can be identified before structural changes of the joints can be detected. Non-radiographic axial SpA usually starts in late adolescence or early adulthood. Onset after the age of 45 is rare. Symptoms include lower back pain with predominant night pains, morning stiffness and impaired physical function as well as chest pain, pain and swelling of peripheral joints and extra-articular tenderness.
First line treatment options for SpA normally include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, however, these are only effective in approximately half of patients. Secukinumab (Cosentyx) is a new treatment option that acts by inhibiting the processes that leads to bone loss and inflammation, thereby reducing the symptoms of the disease. It is administered by injection under the skin (subcutaneous). If licenced, secukinumab could provide an additional treatment option for patients who are intolerant or do not respond adequately to NSAIDs.
Tizanidine as an intranasal spray is being developed as a new treatment option for patients with acute low back pain. It works by blocking pain sensations that are sent to the brain, temporarily relaxing muscle tone. Tizanidine is already available in the tablet form as a short-acting muscle relaxer used to relieve the stiffness and restriction of muscles due to injuries or diseases of the spinal cord. If licensed, tizanidine prepared for intranasal administration will offer an alternative to the oral administration for patients with acute low back pain when short term dosing and a fast effect is desired.