title: Disease-modifying Antirheumatic Drugs for the Treatment of Low Back Pain: A Systematic Review of the Literature.
abstract: Low back pain (LBP) is a common source of pain and disability, which has an enormous adverse impact on affected individuals and the community as a whole. The etiologies of LBP are protean and local inflammation contributes to the majority of these processes. Although an array of potent disease-modifying anti-rheumatic drugs (DMARDs), which are typically anti-inflammatory in character, have become clinically available only corticosteroids are routinely used for the treatment of LBP. To further investigate this potentially underutilized therapy, we reviewed the available literature to determine the role of DMARDs in the treatment of LBP. Our results show that the current DMARD use for LBP is indeed limited in scope and is characterized by isolated use and empiric selection of drugs from a range of available DMARDs. Moreover, the dose, frequency, and route of drug administration are selected arbitrarily and deviated from treatment protocols proposed for the management of other inflammatory conditions. The literature published on this topic is of low quality, and the results of the reviewed trials were inconclusive or demonstrated only short-term efficacy of these medications. Based on the findings of this review, we recommend that the future DMARD use for LBP is initially limited to patients with debilitating disease who are unresponsive to conventional treatments, and the criteria for drug selection and routes of drug administration are clearly defined and may be modeled after treatment protocols for other inflammatory conditions.
authors.affiliation: Department of Anesthesiology, Northwestern University, Chicago, Illinois, U.S.A.
authors.forename: Khalid M
authors.initials: KM
authors.lastname: Malik
authors.affiliation: Department of Anesthesiology, Northwestern University, Chicago, Illinois, U.S.A.
authors.forename: Ariana
authors.initials: A
authors.lastname: Nelson
authors.affiliation: Department of Anesthesiology, Northwestern University, Chicago, Illinois, U.S.A.
authors.forename: Honorio
authors.initials: H
authors.lastname: Benzon
mesh_terms: D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents
keywords: DMARD; disease-modifying agents; disease-modifying antirheumatic drugs; low back pain; systematic review