There is currently no cure for ankylosing spondylitis (AS), but there are treatments available, such as physiotherapy, exercise, medication and, in severe cases, surgery, that can relieve symptoms of the disease.
Physiotherapy and exercise
A tailored physiotherapy and exercise plan is important for those with AS.
A physiotherapist can design a program of stretching, deep breathing, and range-of-motion exercises. This specialist also can offer advice about maintaining good posture and may suggest hydrotherapy, or special exercises in a warm-water pool.
Physiotherapy and exercise can prevent stooping and stiffness of the spine, keep the back flexible, make daily activities easier, and lower the chances of someone with AS experiencing severe pain or injuring themselves further.
A rheumatologist can prescribe painkillers to help people with AS manage their condition.
Non-steroidal anti-inflammatory drugs (NSAIDs)
The first type of painkiller that a doctor usually prescribes for AS is a NSAID such as ibuprofen, naproxen, or diclofenac.
NSAIDs can ease pain and relieve swelling in the joints. Some tablets have a slow-release formulation, which can help with night-time pain and morning stiffness. NSAIDs also are available as gels that can be applied to the painful area.
NSAIDs sometimes have side effects. Doctors can reduce this risk by prescribing the lowest possible dose for the shortest possible time. Serious side effects associated with NSAIDs include stomach bleeding, heart attack, and stroke.
Paracetamol is a painkiller that doctors often recommend if NSAIDs are unsuitable. It is particularly useful just before physical activity to keep pain to a minimum.
Paracetamol rarely has side effects, so patients can take it regularly. Women who are pregnant or breastfeeding also can use it. However, paracetamol can be unsuitable for people with liver problems or who are alcohol-dependent.
Codeine is a stronger type of painkiller. Doctors prescribe it in addition to paracetamol when conditions warrant. It can cause side effects including nausea, vomiting, constipation, and drowsiness. Codeine also can be addictive.
Anti-tumor necrosis factor medications, also called TNF inhibitors, are a newer type of injected medication that can alleviate AS symptoms.
TNF is a protein involved in inflammation. TNF inhibitors prevent TNF from causing inflammation and reduce inflammation that has already developed in the joints.
Doctors need to keep a close watch on the effects of anti-TNF medications as they are not suitable for everyone, and should be prescribed only if a person’s AS symptoms can’t be controlled with physiotherapy and NSAIDs.
Anti-TNF treatments include Enbrel (etanercept), Humira (adalimumab), Cimzia (certolizumab pegol), and Simponi (golimumab).
Interleukins signal immune cells to activate inflammation.
Normally, interleukin-17 (IL-17) helps the body defend itself against infections. But high amounts of it can cause joint inflammation, bone erosion, and bone fusion in AS patients. IL-17 inhibitors block IL-17, reducing inflammation.
Cosentyx (secukinumab) and Taltz (ixekizumab) are two IL-17 inhibitors that the U.S. Food and Drug Administration (FDA) approved for the treatment for AS. However, like TNF inhibitors, they increase the risk of infection.
Scientists have linked another signaling molecule, IL-23, to AS because it also tempers the production of IL-17.
Stelara (ustekinumab) is an IL-23 and IL-12 inhibitor. The FDA has approved it as a treatment for psoriatic arthritis, plaque psoriasis, and Crohn’s disease.
Clinical trials have shown that Stelara also can reduce the symptoms of AS and that patients can tolerate it well.
Corticosteroids, which have a powerful anti-inflammatory effect, can be used as a short-term treatment for AS flare-ups. Patients can take them as tablets or an injection.
If a joint is inflamed, a corticosteroid can be injected directly into it.
Doctors usually prescribe no more than three corticosteroid injections a year, with at least three months between injections in the same joint. That is because corticosteroid injections can cause a number of side effects, including infections.
Most people with AS do not need surgery.
In severe cases, doctors may recommend joint replacement surgery to improve pain and movement. Examples are hip or knee replacement operations. The surgery can get rid of pain and improve mobility.
Spinal surgery carries many risks, so surgeons perform operations to straighten a bent spine only in rare cases.
Last updated: May 20, 2020
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