Understanding Ankylosing Spondylitis: Treatment

There is no cure for ankylosing spondylitis (AS). ​Your experience with the disease may not be like anyone else's. But different therapies may offer ways to manage your pain, ease or slow the damage to your joint, and treat other symptoms.

Medications

It’s important to start on AS drugs in your early stage to slow the disease. Medications may help lessen your symptoms and prevent more damage. Your doctor may prescribe one or more of these:

NSAIDs. Nonsteroidal anti-inflammatory drugs likely will be the first class of medication you try. They treat the stiffness and pain. Not all NSAIDs work the same on everyone. It may take a couple of weeks before you can tell if they help with your symptoms. Studies show that NSAIDs will not keep AS from getting worse.

You can buy some NSAIDs over the counter (OTC). They include aspirin, ibuprofen, and naproxen.

If OTC medication don’t help enough, your doctor may prescribe stronger NSAIDs, such as:

NSAIDs may raise your risk for heart disease. Tell your doctor if you have had problems.

Disease-modifying antirheumatic drugs (DMARDs). They are long-term treatments. Your doctor may have you try DMARDs if NSAIDs haven’t helped or if you’ve had trouble with side effects. DMARDs, which block inflammation to prevent joint damage, include:

Your doctor will check your blood regularly to keep an eye on your liver and possible complications.

Corticosteroids. This lab-made steroid helps relieve inflammation right away. You will find it under the name prednisone or cortisone. Take it as a pill, a cream, or a shot directly into the joint. Corticosteroids are a quick fix to stop the pain in a specific area of your body and but are not a long-term solution. Your doctor may give you corticosteroid drops for inflammation in your eye, which is one of the most common complications of AS.

Biologics. These are drugs made from living cells. Biologics can work quickly and well for AS. They include:

  • TNF inhibitors. These are highly effective for treating inflammation of your joints, gut, and eyes. The FDA has approved several TNF inhibitors for AS. These drugs can make it harder for your body to fight infections. Medications in this class include adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), infliximab (Remicade), and golimumab (Simponi).
  • Interleukin 17 inhibitors. They’re also called IL-17 inhibitors. You may get them if TNF inhibitors don’t work for you. The FDA has approved two IL-17 inhibitors for AS: ixekizumab (Taltz) and secukinumab (Cosentyx).

Anti-ulcer drugs. Sometimes AS can lead to gastrointestinal issue such as belly pain, diarrhea, or constipation. Misoprostol (Cytotec) or sucralfate (Carafate) may help protect your stomach and intestinal lining.

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Lifestyle Habits

Medication is only one part of your AS treatment.

Keep active. Exercise is proven to benefit AS. It can lessen your pain, strengthen your muscles, and make you more flexible. Group exercises with supervision is a good choice. Or you can stay active on your own or at home. You might try:

Eat a healthy diet. Certain foods may help lower inflammation in your joints and improve bone health. Some good eating tips include:

  • Get more calcium
  • Eat more fish, beans, nuts, and eggs
  • Limit red meat
  • Load up on omega-3 fatty acids found in salmon, flax seeds, and certain nuts

Get outside. People with AS are found to have lower levels of vitamin D, which protects your bones and helps keep them strong. Your body makes vitamin D from sunlight on your skin. You also can eat foods enriched with the vitamin.

Quit smoking . It can speed up damage to your joints and make breathing harder. Ask your doctor how you can get help to quit.

Complementary and Other Treatments

These therapies may work alongside your medications and exercise to ease your AS symptoms.

Acupuncture. This uses needles inserted through your skin at specific points in the body to stimulate nerves, tissues, and muscles. Acupuncture has long been used to treat pain. If you do it, be sure to work with a trained professional.

Massage. Studies have shown that massage helps with pain, stiffness, and tiredness caused by AS. It can also lower your stress and improve your well-being. The increased blood flow can help with flexibility.

Heat and cold treatment. Hot baths and showers, as well as heating pads, can help with pain and stiffness. Cold compresses may lower your inflammation.

Physical therapy. You work with a health care professional to learn which exercises will strengthen and stretch your muscles. Studies suggest that physical therapy can help lessen AS pain as well as improve your posture, chest expansion, and your ability to breathe.

Talk therapy. A lifelong condition like AS can lead to anxiety or depression. Psychotherapy, or talk therapy, is a mental health treatment that helps you change your outlook. It also may help to connect with a support group and talk to people who understand what you’re going through. You can find groups that meet online or in person.

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Surgery

This is a rare option for AS. Your doctor may suggest surgery if your pain is severe even with medication and if you have a deformity that affects how you move. Types of surgery for AS include:

Laminectomy. This surgery helps with the pain in your arms and legs but not your back. The doctor removes part of the spinal bone to open up space for cramped, painful nerves. This is often done with a spine fusion to add more back support.

Osteotomy. This is done to correct a curved spine that hinders your movement or ability to stand up. It will improve your ability to walk but will not bring back your full mobility. The doctor removes part of the bone and realigns the spine.

Spinal fusion. Often done with a laminectomy or osteotomy, this procedure makes the spine more stable. You will also heal faster because you have more support. The surgeon uses rods, bars, and wires to stabilize the spine.

Hip replacement. This surgery is uncommon for people with AS. It can relieve pain and bring back mobility to your hips. The surgeon replaces your damaged joints with an artificial hip.

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on November 17, 2020

Sources

SOURCES:

Arthritis Foundation: “Axial Spondyloarthritis, Methotrexate: Managing Side Effects, Corticosteroids,” “RA and Gastrointestinal Problems,” “Six Ways Arthritis Can Affect Your Eyes,” “Treating Depression and Anxiety in Arthritis.”

Cleveland Clinic: “Corticosteroids.”

Mayo Clinic: “Ankylosing Spondylitis,” “Laminectomy,” “Hip Replacement.”

Spondylitis Association of America: “Medications to Treat Ankylosing Spondylitis and Related Diseases,” “Diet’s Effect on Spondylitis Symptoms,” “Complementary Treatments.”

Ankylosing Spondylitis: “NSAIDs, Non-Steroidal Anti-Inflammatory Drugs,” “Bowel Inflammation and Ankylosing Spondylitis,” and “Spinal Surgery.”

The National Center for Biotechnology Information: “Non-steroidal Anti-inflammatory Drugs Are unlikely to Inhibit Radiographic Progression of Ankylosing Spondylitis: A Systematic Review,” “Comparative Effectiveness of Biologic Therapy Regimens for Ankylosing Spondylitis,” “Effects of physical therapy for the management of patients with ankylosing spondylitis in the biological era,” “[Home based and group exercise programs in patients with ankylosing spondylitis: systematic review],” “The Effects of Massage on Pain, Stiffness, and Fatigue Levels Associated with Ankylosing Spondylitis: A Case Study,” “Effects of the Disease Characteristics and the Treatment of Psychological Status in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis,” “Vitamin D levels in patients with ankylosing spondylitis: Is it related to disease activity?”

Versus Arthritis: “Ankylosing Spondylitis.”

Med Shadow: “What are biologics?”

NHS: “Treatment.”

National Axial Spondyloarthritis Society: “Your Diet.”

Arthritis Research UK: “Keeping Active with Ankylosing Spondylitis.”

Research Gate: “The role of exercise in the rehabilitation of ankylosing spondylitis.”

Michigan Medicine: “Ankylosing Spondylitis.”

National Osteoporosis Foundation: “Calcium and Vitamin D.”

University of Washington: “Ankylosing Spondylitis.”

The Spine Hospital: “Ankylosing Spondylitis.”

University of Maryland Medical Center: “Ankylosing Spondylitis.”

Hospital for Special Surgery: “Ankylosing Spondylitis: An Overview,” “Hip and Knee Replacement Surgery FAQs.”

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