How is Ankylosing Spondylitis Treated?

A healthcare provider will likely suggest a combination of medications, physical therapy, and complementary medicine to treat ankylosing spondylitis (AS). AS is a type of inflammatory arthritis that primarily affects the joints in the spine and causes chronic back pain and stiffness. AS can also limit your flexibility and range of motion.

Receiving an early AS diagnosis can help you start treatment sooner and improve your quality of life. The main goals of treatment are to reduce pain and inflammation, maintain the function of your joints, and slow disease progression.

Medications 

There are several types of medications used to treat AS. Treatments work differently from person to person. It may take some time to find the right combination of medicines that work best for you. A healthcare provider may prescribe one or more of the following medications. 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) are often the first line of treatment for AS. These medicines reduce joint pain by blocking the production of certain chemicals in the body that can play a role in inflammation.

Some NSAIDs, like Advil (ibuprofen) or Aleve (naproxen), are available over-the-counter (OTC) at your local drug store or supermarket. Let a healthcare provider know if OTC medications aren't improving your condition. They may opt to prescribe you a stronger type of NSAID to manage more severe pain and inflammation. Prescription NSAIDs may include Celebrex (celecoxib) or Voltaren (diclofenac).

NSAIDs are generally safe to use. Some people may experience side effects like bloating, constipation, heartburn, and nausea after taking higher doses. Long-term use of NSAIDs may increase blood pressure, as well as your risk of stomach ulcers, kidney problems, or heart conditions. Those with underlying chronic kidney disease, a history of peptic ulcer disease, and heart disease cannot take these medications.

Disease-Modifying Antirheumatic Drugs (DMARDs) 

Disease-modifying anti-rheumatic drugs (DMARDs), such as Otrexup (methotrexate), calm down your immune system and reduce inflammation in your body. There is no evidence that shows DMARDs help lower the pain in your back or neck. There are also synthetic DMARDs, such as janus kinase (JAK) inhibitors, which are approved for AS.

DMARDs can still be useful for people with pain in their peripheral joints, like the knees, hips, and ankles. These drugs can stop disease progression and reduce the risk of peripheral joint damage.

DMARDs are not risk-free, like most medications. Some side effects include headaches, hair loss, bloating, stomach pain, and nausea. Although rare, taking DMARDs long-term can lead to changes in your liver function. Certain DMARDs can also cause changes in blood counts and lung issues.

Biologics 

Biologics are a type of DMARDs that can reduce inflammation. A healthcare provider may typically advise a biologic drug if your body has not responded well to other medications. 

There are two types of biologics that help treat AS:

• Interleukin-17 (IL-17) inhibitors: IL-17 is a type of protein that activates your body's inflammatory response. IL-17 inhibitors are drugs that inhibit (block) your immune system from producing inflammation. You may experience less pain and swelling in your joints.
• TNF inhibitors (TNFi): TNFi inhibitors target specific parts of the immune system that play a role in producing inflammation. These medications inhibit tumor necrosis factor-alpha (TNF-a). This protein that regulates inflammatory processes in your immune system. This medication can reduce joint inflammation and relieve pain.

It's important to note that biologics are not oral pills, unlike NSAIDs or traditional DMARDs. A healthcare provider administers biologics through an injection or intravenous (IV) infusion.  

The most common biologics that treat AS are:

Biologics usually cause fewer side effects than NSAIDs. You may become more vulnerable to infections or experience a longer recovery time when you have an infection since biologics suppress the immune system.

Corticosteroids 

Corticosteroids, such as Rayos (prednisone), are a less common treatment for AS. They can still help treat the condition in the short term. These medications can effectively reduce inflammation and pain.

Oral and injectable corticosteroids can have serious side effects. A healthcare provider will not recommend them for long-term use.

Physical Therapy 

A healthcare provider may also recommend physical therapy to treat your condition. Research has shown that physical therapy may be beneficial for pain, mobility, flexibility, physical function, and quality of life in people with AS. This treatment may help prevent further joint damage and slow disease progression.

Physical therapy typically includes exercises and stretches that maintain or improve the range of motion in your spine and other joints. A physical therapist may include the following during your sessions:

• Aerobic exercises: Incorporate cardio exercises, like walking or biking, to better heart and lung function, endurance, and mood  
• Balance exercises: Focus on enhancing strength and stability to reduce the risk of falls and other injuries 
• Strengthening exercises: Done with weights or resistance bands to maintain or boost muscle strength and endurance to support the spine and other joints 
• Stretching exercises: Improve flexibility and range of motion in the spine and other joints

Physical therapists will typically work closely with you to develop a personalized exercise program that is safe and effective for your condition. They will provide education and guidance on proper posture to relieve symptoms and lower the risk of injury.

Surgery

Most people with AS won't need surgery. An aggressive case of AS or intense spinal pain that limits your ability to perform daily tasks may make surgery an option. A healthcare provider will likely consult with a rheumatologist (who specializes in the joints, bones, and muscles) and a surgeon to figure out what options are right for you.  

The type of surgery they decide on will depend on several factors. These include your symptoms, the severity of pain, whether you have any joint deformities, and what joints are affected. Other factors include your age, lifestyle, and overall health. 

The most common surgeries for AS include: 

• Hip replacement: Removes the damaged ball and socket joint of the hip and replaces it with an artificial joint to improve mobility and reduce pain
• Laminectomy: Takes out a portion of the spinal vertebrae (lamina) to relieve pressure on the spinal cord and nerves
• Spinal fusion: Joins two or more spinal vertebrae (a series of small bones) to create a single, solid bone to stabilize the spine and relieve severe back pain
• Spinal osteotomy: Cuts and reshapes the spinal vertebrae to correct any deformities or problems with posture
  

Complementary and Alternative Medicine 

Some people with AS seek complementary and alternative medicine (CAM) treatments in addition to conventional treatments. Research on the effectiveness of CAM therapies is ongoing. Some evidence suggests that these therapies can help improve AS symptoms.

You may consider trying the following if you're interested in CAM therapies to manage AS: 

• Acupuncture: A traditional Chinese medicine technique that inserts thin needles in the body to help relieve pain and swelling and promote relaxation
• Massage therapy: Uses different pressures and movements to relieve pressure, reduce muscle tension, and increase range of motion
• Tai chi: A form of martial arts that incorporates slow movements and deep breathing, which can improve flexibility in your spine and reduce pain in your body
• Yoga: Uses a variety of breathing and stretching exercises to help reduce pain, improve mobility in the spine, increase strength, and boost mood
  

Keep in mind that spinal manipulation via a chiropractor is not recommended for people with AS patients. There's a risk for spinal fracture, herniation, and vessel dissection.

Living With and Managing Ankylosing Spondylitis 

Living with ankylosing spondylitis can be challenging and significantly affect your daily life. Getting started on treatment as soon as you receive a diagnosis for AS can improve your quality of life and reduce how fast symptoms progress. Untreated AS can lead to disability and loss of mobility over time. 

It's possible to live a long and healthy life with AS with the right treatments, tools, and support. You may also consider trying other recommendations that can make your life easier once you find a treatment regimen that works for you.

This might include:

• Buying a grabber to help reach things on grocery store shelves or cupboards
• Modifying your home to make it more accessible by installing grab bars in the bathroom,
• Using assistive devices such as a cane to help you get around

A Quick Review

Getting started on treatment as soon as you receive an AS diagnosis is essential to relieve symptoms and improve your quality of life. Treatment options may include a combination of medications, physical therapy, and complementary medicines.

Medications can help control inflammation and reduce pain. Physical therapy and complementary medicines can improve your range of motion and promote relaxation. A healthcare provider may recommend surgery if you have a severe case of AS.