Ankylosing spondylitis (AS) is a form of arthritis that’s associated with long-term inflammation of the joints in the spine. The result is pain and stiffness in the back and hips—symptoms that tend to get worse as the years go by. AS can also lead to complications such as a stooped posture, eye or bowel inflammation, and reduced lung or heart function.
Fortunately, there’s a lot you can do to fight back. Proper treatment helps ease pain and stiffness, and it might also prevent or delay complications. Treatment is generally most effective when started early, before the disease causes permanent joint damage.
Here’s an overview of the treatment options for AS. By working closely with your health care team, you can find the best combination of treatments for you.
Several types of medication are helpful for AS, but some may work better for you than others. You’ll probably wind up taking one or more of the following:
Nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs are the most widely used type of medication for treating AS. They include ibuprofen (such as Advil, Motrin), indomethacin (Indocin), and naproxen (such as Aleve, Naprosyn). NSAIDS can help relieve inflammation, pain, and stiffness. Long-acting ones taken at night may improve sleep as well. However, high doses may be needed to ease symptoms of the disease. That increases the chance for side effects, such as upset stomach, heartburn, or, less often, bleeding stomach ulcers or kidney disease.
Corticosteroids. When NSAIDs alone don’t provide enough relief, doctors may prescribe one of these potent inflammation-fighters. Sometimes, a corticosteroid injection (such as cortisone) is given in an inflamed joint for fast but temporary relief. Other times, an oral corticosteroid (such as prednisone or prednisolone) is prescribed for a short time. This can help calm down a flare or get a new exercise program off to a strong start. However, corticosteroids usually aren’t taken for long due to the risk for numerous side effects.
Tumor necrosis factor (TNF) inhibitors. These genetically engineered drugs block a particular cell protein that triggers inflammation. They include adalimumab (Humira), etanercept (Enbrel), golimumab (Simponi), and infliximab (Remicade). TNF inhibitors—taken by injection or through an IV line—can help reduce joint pain, stiffness, and swelling. They may be effective even when NSAIDs are not. But like other drugs, they can have side effects. The most serious one is an increased risk for infections, especially tuberculosis.
Disease-modifying antirheumatic drugs (DMARDs). These drugs aren’t considered primary treatment options for AS, but they may be used in severe cases. They target the process that sets the disease in motion. Sulfasalazine (Azulfidine) is the most commonly prescribed DMARD for AS. It may help control not only joint disease, but also the bowel inflammation that sometimes goes along with it. One rare but serious side effect is bone marrow suppression.
Exercise plays a key role in managing AS. Done carefully and consistently, it can help lessen your pain and keep you moving. Your doctor might suggest working with a physical therapist to develop an exercise plan that’s suited to your needs. Two types of exercise are particularly important:
Strengthening exercises. Stronger muscles provide better support for painful joints. Strengthening exercises may be done with weights or weight machines. A physical therapist might also show you how to tighten and release your muscles without moving your joints so you can keep building strength even during disease flares.
Range-of-motion exercises. Stretching helps maintain joint flexibility and preserve good posture. A physical therapist can show you how to safely stretch your back even when it’s painful and stiff. In the long run, this can help ward off disability.
Practicing good posture is another crucial element of treatment. In some people with AS, long-term inflammation causes bones of the spine to fuse together. Posture training may influence the pattern of fusion so that the spine doesn’t become locked into a hunched-over position. This affects not only how you look, but also how well you’re able to get around.
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, when it’s more possible to correct them. 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 face-down on the floor or a firm bed for up to several minutes at a time.
Heat and Cold Therapy
Applying heat or cold to the affected area may make you more comfortable. Heat helps ease pain and soreness in stiff joints and tight muscles. A warm bath or shower is often a soothing choice. Or you might try a heating pad, hot pack, or heated washcloth.
Cold helps reduce swelling around inflamed joints. A cold pack can also numb a sore area when you’re in the midst of a flare.
Surgery is not a primary treatment for AS. However, sometimes inflammation affects joints outside the spine. If you have joint damage to your hip or knee that’s severe enough to make it hard to get around, joint replacement surgery might be recommended.
Rarely, an operation called an osteotomy may be performed to straighten the spine after it has fused into a stooped position. This surgery involves cutting and realigning bones of the spine. Because it’s considered high risk, osteotomy isn’t a common option.