From Mr K. Cooke
I commend Navjot Nannar for his comprehensive review of managing ankylosing spondylitis (AS). Having suffered from AS for nearly 40 years and with a wife who was a pharmacist until her retirement, I might be considered an expert patient.
The diagnosis of AS used to be notoriously slow but the symptoms are now more readily recognised. Confusingly, different AS patients can show different selections of symptoms and the severity of each can vary widely.
I have been taking the newly approved (for AS) antitumour necrosis factor agent adalimumab by self-injection and have just passed the 12-week review date. It has substantially improved my condition and brought great benefits to my lifestyle.
Dr Nannar descibes the association of AS with a genetic marker, HLA B27. Readers might like to know that other genetic factors have also been identified and that research continues into their relevance.
Ken Cooke Ilkley, West Yorkshire
Article should have been more comprehensive
From Mr S. M. Canning, MRPharmS
The continuing professional development article about treating acute diarrhoea in adults is primarily directed at pharmacists facing these situations on a daily basis, therefore, I think it could have been more comprehensive.
The management section details groups of drugs without listing any proprietary products for a practical guide. Obviously, it could not have included all the products on the market but at least some would have been better than none.
Also, who has not heard about the use of flat cola for treating diarrhoea? Some doctors even recommend this as a remedy. No mention of this was made with discussion about the pros and cons of using this treatment.I believe that, had the article been written by a pharmacist working in the field, it would have been of more practical use.
Stanley Canning
Israel
Different types of acute diarrhoea
This four-page article covered different types of acute diarrhoea in adults (including food poisoning and adverse drug reactions), management with oral
rehydration salts, opioids and adsorbents, when antibiotics might be appropriate, advice pharmacists can give on prevention and prophylaxis of travellers’ diarrhoea, and symptoms that need to be referred.
Regular readers of our CPD section will know that our articles cover active drugs and that proprietary brands are rarely mentioned. Some ailments have too many over-the-counter products to list and to mention only a few could be perceived as biased.
With regard to the use of flat cola to treat diarrhoea, many pharmacists have heard of people being advised to use flat soft drinks by friends or relatives. According to recent research, there are little data for, and some evidence against, this practice (Archives of Disease in Childhood 2008;93:129–31). The researchers concluded that flat soft drinks are not an effective substitute for oral rehydration solutions, which contain the correct amounts of salts and glucose. I would imagine, in any case, that most pharmacists would advise people only to resort to using flat soft drinks when rehydration sachets and clean water are not available.
The author of the article, Alan Nathan, is a practising pharmacist. Readers with queries are invited to use our “ask the expert” facility on PJ Online, which is available for two weeks after the publication of each CPD article. PJ Online can also be used to comment or to begin debates on issues, such as the recommendation to use flat soft drinks for diarrhoea.
Lin-Nam Wang Senior contributions editor The Pharmaceutical JournalAnkylosing Spondylitis
Dear Ken
Thank you for your kind words. Your comments are very much appreciated considering your first hand experience in the condition.
It is a condition that doesn't have much exposure and its probably fair to assume that particularly in the community, there is little understanding into it. However, the article hopefully raised the profile and appreciation for what can be challenging to the patient as well as the healthcare professionals involved. It is also reassuring to know that those affected do not have to despair with what can sound alarming at first, but learn new skills that helps them with those around them to best manage this.
humble regards
Dr N Nannar
GMC: 7013724
RPSGB: 1072039