Treatment for Ankylosing Spondylitis

Medications

Several types of medication are helpful for AS, but some may work better for you than others. Your doctor may recommend one or more of the following treatments for the causes and symptoms of AS.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most common treatments for AS, including:

• ibuprofen (Advil)
• indomethacin (Indocin)
• naproxen (Aleve, Naprosyn)

NSAIDs can help relieve:

• swelling
• pain
• stiffness

Some NSAIDs are long-acting and can be taken at night to help improve sleep as well.

Using high doses of NSAIDs or long-acting medications can sometimes cause side effects, such as:

• upset stomach
• heartburn
• bleeding stomach ulcers
• kidney or heart disease

Talk to your doctor about the risk of these side effects. High doses may be needed to help ease your symptoms.

Tumor necrosis factor inhibitors

Tumor necrosis factor (TNF) inhibitors are medications meant to help modify your immune system’s creation of a protein that triggers inflammation.

Here are some examples of TNF inhibitors:

• adalimumab (Humira)
• etanercept (Enbrel)
• golimumab (Simponi)
• infliximab (Remicade)

You can take TNF inhibitors either through an injection or an intravenous (IV) line. They’re used to help reduce:

• joint pain
• stiffness
• swelling

TNFS can also help prevent radiographic (structural) damage.

TNF inhibitors can be effective when NSAIDs aren’t enough to reduce pain or swelling.

However, they can have side effects, too. They may increase your risk for infections like tuberculosis. Talk to your doctor about how TNF inhibitors might affect you.

Disease-modifying antirheumatic drugs

Disease-modifying antirheumatic drugs (DMARDs) aren’t usually a first-line treatment for AS. But they may be used if your AS symptoms are severe and biologics are not an option.

DMARDs target the immune response involved in the inflammation.

Sulfasalazine (Azulfidine), also known as SSA, is the most commonly prescribed DMARD for AS. It may help manage not only joint disease but also the bowel inflammation that sometimes goes along with it.

SSA is used as a treatment in Europe, but it’s rarely used in the United States.

One rare — but serious — side effect is bone marrow suppression. SSA can also decrease sperm count in males.

Injections

Injections are used to put steroids and other AS medications into your joints to help relieve pain and stiffness.

There are three different types of injections for AS:

• intra-articular injection: injected directly into your joint
• periarticular injection: injected into soft tissue near your joint
• intramuscular injection: injected in your muscle

Here are some injections that your doctor may recommend:

• hydrocortisone (Cortef)
• triamcinolone
• methylprednisolone

Physical therapy

Exercise is key to managing your AS.

Consistent exercise can help reduce pain and help you stay mobile. Your doctor may also suggest working with a physical therapist to develop an exercise plan that’s best suited to your needs.

Here are two types of exercise that can be especially helpful.

Strengthening exercises

Stronger muscles provide better support for painful joints. To perform strengthening exercises, try using weights or weight machines.

Your physical therapist might also show you how to tighten and release your muscles without moving your joints so you can keep building strength even when your AS flares up.

Range-of-motion exercises

Stretching helps keep your joints flexible and maintain your posture.

Your physical therapist can show you how to safely stretch your back even when it’s painful and stiff.

This can help you reduce the chances of losing mobility or feeling increasing amounts of discomfort over time, which can help prevent disability.

Posture training

Practicing good posture is another good way to help treat AS.

In some cases, AS can cause long-term inflammation that results in bones of the spine fusing together.

Posture training can help influence how your spine fuses so that your spine doesn’t become locked into a hunched-over position. This position can affect how well you can move around and how your posture looks.

One component of good posture is awareness. You can learn how to check your posture in a full-length mirror. Done regularly, this helps you detect any changes early and increases the potential for correction.

You can also start paying closer attention to how you sit, stand, and walk. This helps you break the habit of slouching and focus on holding yourself up straight.

In addition, you can do posture exercises. One of the simplest and best involves lying facedown on the floor or a firm bed for up to several minutes at a time.

Heat/cold compress

Try applying a hot pack or cold pack to the affected area to help relieve pain and make yourself more comfortable.

Heat is good for pain and soreness in stiff joints and tight muscles. A heating pad or hot washcloth in the affected area can also help. A warm bath or shower can relieve pain, too, while also helping you relax.

Cold helps reduce swelling around inflamed joints. Try a cold pack to numb a sore area when you have a flare-up.

Surgery

Surgery is avoided as much as possible for the treatment of AS because of the likelihood of post-surgery hypertrophic bone growth. This post-surgery condition can cause more problems than the original condition.

There are some situations where surgery may be necessary. For instance, when you have joint damage to your hip or knee that makes it difficult to walk or do other daily tasks.

In very rare cases, your doctor may recommend a type of surgery called an osteotomy. This is done by cutting and realigning your bones to help straighten your spine if it’s become fused into a stooped position.

Osteotomies can be high-risk procedures. Your doctor won’t likely recommend this surgery unless your AS is severe and disruptive to your daily life.

Cure update

There’s currently no known cure for AS.

However, researchers have identified the gene that increases the risk of developing AS, which increases the possibility that more targeted therapies may eventually lead to a cure for the condition.

The gene is called human leukocyte antigen B27 (HLA-B27), and it’s known to be one of the main risk factors for the inflammation in AS.

The trigger responsible for activating this gene is likely protein fragments, such as bacteria or a virus.

It’s important to note that a person may have HLA-B27 and not develop AS or another autoimmune disease.

Also, genes involved in the interleukin-23/interleukin−17 (IL-23/IL-17) axis may play a part in the development of AS.

They can help your immune system produce inflammation and might be influenced by other parts of your body, such as your gut bacteria, which can eventually result in AS.

Researchers are looking more closely at this pathway and the other bodily functions these interleukins control to help move the medical field closer to a potential cure for AS.

Takeaway

AS can cause pain and stiffness, making it hard to stay active and do daily tasks.

However, there are a number of things you can do to help reduce your symptoms and treat both your pain and stiffness.

Taking these steps can help prevent AS from fusing your spine and making it hard to walk or stand up straight.

Talk to your doctor about the different treatment options for AS.

Surgery and medications may be necessary if your symptoms are severe, but in many cases, exercise and steroid treatments may be enough to help manage your symptoms.