How is Ankylosing Spondylitis Treated?

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that primarily affects the joints in the spine. AS also causes chronic back pain and stiffness, which can limit your flexibility and range of motion. As the condition progresses, you may also notice pain in other joints, including your hips, shoulders, and ankles.

If you notice symptoms of AS, it’s good practice to see your healthcare provider for testing. Receiving an early diagnosis can help you get started on treatment sooner, thereby improving your quality of life. The main goal of treatment is to reduce pain and inflammation, maintain the function of your joints, and slow disease progression. Your healthcare provider will likely suggest a combination of medications, physical therapy, and complementary medicine to treat AS.

Medications 

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

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first line of treatment for AS.

These medicines help reduce joint pain by blocking the production of certain chemicals in the body that can cause inflammation. 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 your healthcare provider know if OTC medications aren’t improving your condition. They may opt to prescribe you a stronger type of NSAID to help you manage more severe pain and inflammation. Prescription NSAIDs may include Celebrex (celecoxib) or Voltaren (diclofenac).

NSAIDs are generally safe to use, but some people may experience side effects such as bloating, constipation, heartburn, and nausea after taking higher doses. Long-term use of NSAIDs may increase your risk of stomach ulcers, kidney problems, or heart conditions.

Disease-Modifying Antirheumatic Drugs (DMARDs) 

Disease-modifying anti-rheumatic drugs (DMARDs)—such as Otrexup (methotrexate)—work by calming down your immune system and reducing inflammation in your body. Currently, there is no evidence that shows DMARDs help lower the pain in your back or neck. But, DMARDs can be useful for people who have pain in their peripheral joints, like the knees, hips, and ankles.

Like most medications, DMARDs are not risk-free. Some side effects of DMARDs include headaches, hair loss, bloating, stomach pain, and nausea. In rare cases, taking DMARDs long-term can lead to changes in your liver function.

Biologics 

Biologics are a newer type of DMARDs that can help reduce inflammation. Typically, your healthcare provider may recommend a biologic drug if your body has not responded well to other medications. 

There are two types of biologics that help treat AS:

• 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)—a protein that regulates inflammatory processes in your immune system. By blocking this protein, this medication can reduce joint inflammation and relieve pain. 
• 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 (or, block) your immune system from producing inflammation. As a result, you may experience less pain and swelling in your joints. 

It’s important to note that unlike NSAIDs or traditional DMARDs, a biologic is not an oral pill. Instead, your healthcare provider will administer biologics through an injection or intravenous (IV) infusion. 

The most common biologics that treat AS are:

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

Corticosteroids 

Corticosteroids, such as Rayos (prednisone), are a less common treatment for AS, but can help treat the condition short-term. These medications can effectively reduce inflammation and pain. However, oral and injectable corticosteroids can have serious side effects, so your healthcare provider will not recommend them for long-term use.

Physical Therapy 

In addition to medication, your provider may recommend physical therapy to treat your condition. Research shows that physical therapy may be beneficial for pain, mobility, flexibility, physical function, and quality of life in people with AS. In people in earlier stages of AS, physical therapy may also help prevent further joint damage and slow disease progression.

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

• Stretching exercises: Improve flexibility and range of motion in the spine and other joints
• Strengthening exercises: Done with weights or resistance bands to maintain or boost muscle strength and endurance to support the spine and other joints 
• 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 

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

Surgery

Most people with AS won’t need surgery. But, if you have an aggressive case of AS or intense spinal pain that limits your ability to perform daily tasks, surgery might be an option. Your healthcare provider will likely consult with a rheumatologist (a doctor who specializes in the joints, bones, and muscles) and a surgeon to figure out which surgical options are right for you.  

The type of surgery they decide on will depend on several factors: your symptoms, the severity of your spinal pain, whether you have any joint deformities, which joints are affected, and 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 help improve mobility and reduce pain
• Laminectomy: Takes out a portion of the spinal vertebrae (called the lamina) to help relieve pressure on the spinal cord and nerves
• Spinal osteotomy: Cuts and reshapes the spinal vertebrae to correct any deformities or problems with posture
• Spinal fusion: Joins two or more spinal vertebrae (a series of small bones) to create a single, solid bone to help stabilize the spine and relieve severe back pain

Complementary and Alternative Medicine 

Some people with AS seek complementary and alternative medicine (CAM) treatments in addition to conventional treatments, like medication or surgery. Research on the effectiveness of CAM therapies is ongoing, but some studies show promise that these therapies can help improve AS symptoms.

If you’re interested in CAM therapies to manage AS symptoms, you may consider trying: 

• Yoga: Uses a variety of breathing and stretching exercises to help reduce pain, improve mobility in the spine, increase strength, and boost mood 
• Acupuncture: A traditional Chinese medicine technique that inserts thin needles on the body to help relieve pain and swelling and promote relaxation
• 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
• Massage therapy: Uses different pressures and movements to relieve pressure, reduce muscle tension, and increase range of motion

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 your condition progresses. If your condition is left untreated, the disease can lead to disability and loss of mobility over time. 

Once you find a treatment regimen that works for you, you may also consider trying other recommendations that can make your life easier. This might include 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, or buying a grabber to help reach things on grocery store shelves or cupboards. With the right treatments, tools, and support, it is possible to live a long and healthy life with AS. 

A Quick Review

Ankylosing spondylitis (AS) is a condition that causes inflammation and pain in your spine and other joints. 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, while physical therapy and complementary medicines can improve your range of motion and promote relaxation. If you have a severe case of AS or other treatments aren’t helping improve your condition, your healthcare provider may recommend surgery.