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 can also offer advice on 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)
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 are also available as gels that can be applied to the painful area.
NSAIDs can 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 it can be taken regularly. It can also be used by women who are pregnant or breastfeeding. Paracetamol can be unsuitable for people with liver problems or who are alcohol-dependent, however.
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.
Anti-tumor necrosis factor drugs, also called TNF inhibitors, are newer, injected treatments that can alleviate AS symptoms.
TNF is a protein involved in inflammation. The drugs 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 drugs. They are not suitable for everyone, and should be prescribed only if a person’s AS symptoms can’t be controlled with physiotherapy and anti-inflammatory drugs.
Interleukins signal immune cells to activate inflammation.
Normally, interleukin-17 (IL-17) helps the body defend 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.
The only IL-17 inhibitor that the U.S. Food and Drug Administration has approved as a treatment for AS is Cosentyx (secukinumab). Like TNF inhibitors, it increases the risk of infection, however.
Scientists have linked another signaling molecule, IL-23, to AS because it also tempers the production of IL-17.
Corticosteroids, which have a powerful anti-inflammatory effect, can be used as a short-term treatment for AS flare-ups. They can be taken as tablets or injected.
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.
Spinal surgery carries a lot of risk, so surgeons perform operations to straighten a bent spine only in rare cases.
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