Currently, there’s no cure for ankylosing spondylitis (AS). However, most patients with AS can lead long, productive lives.
Because of the time between the onset of symptoms and confirmation of the disease, early diagnosis is essential.
Medical management, ancillary care therapies, and targeted exercises can offer patients improved quality of life. Positive impacts include pain relief, increased range of motion, and increased functional capacity.
The most promising clinical trials are those examining the efficacy and safety of bimekizumab. It’s a drug that inhibits both interleukin (IL)-17A and IL-17F — small proteins that contribute to AS symptoms.
Filgotinib (FIL) is a selective inhibitor of Janus kinase 1 (JAK1), another problematic protein. FIL is currently in development for treatment of psoriasis, psoriatic arthritis, and AS. It’s taken orally and is very potent.
Your eligibility to participate in a clinical trial for AS depends on the purpose of the trial.
Trials may study the efficacy and safety of investigational drugs, the progression of skeletal involvement, or the natural course of the disease. A revision of the diagnostic criteria for AS will influence the design of clinical trials in the future.
The latest FDA approved drugs for treatment of AS are:
- ustekinumab (Stelara), an IL12/23 inhibitor
- tofacitinib (Xeljanz), a JAK inhibitor
- secukinumab (Cosentyx), an IL-17 inhibitor and humanized monoclonal antibody
- ixekizumab (Taltz), an IL-17 inhibitor
Complementary therapies that I routinely recommend include:
- massage
- acupuncture
- acupressure
- hydrotherapy exercises
Specific physical exercises include:
- stretching
- wall sitting
- planks
- chin tuck in recumbent position
- hip stretching
- deep breathing exercises and walking
The use of yoga techniques and transcutaneous electrical nerve stimulation (TENS) units are also encouraged.
Surgery is rare in AS. Sometimes, the disease progresses to the point of interfering with daily activities because of pain, limitations of motion, and weakness. In these cases, surgery might be recommended.
There are a few procedures that can decrease pain, stabilize the spine, improve posture, and prevent nerve compression. Spinal fusion, osteotomies, and laminectomies performed by very skilled surgeons can be beneficial to some patients.
It’s my impression that treatments will be tailored based on specific clinical findings, improved imaging techniques, and any associated expressions of this disease.
AS falls under the umbrella of a broader category of illnesses called spondyloarthropathies. These include psoriasis, psoriatic arthritis, inflammatory bowel disease, and reactive spondyloarthropathy.
There can be crossover presentations of these subsets and people will benefit from a targeted approach to treatment.
Two specific genes, HLA-B27 and ERAP1, could be involved in the expression of AS. I think the next breakthrough in the treatment of AS will be informed by understanding how they interact and their association with inflammatory bowel disease.
One major advancement is in nanomedicine. This technology has been used to successfully treat other inflammatory diseases like osteoarthritis and rheumatoid arthritis. The development of nanotechnology-based delivery systems might be an exciting addition to the management of AS.
Brenda B. Spriggs, MD, FACP, MPH, is Clinical Professor Emerita, UCSF, Rheumatology, a consultant for several health care organizations, and an author. Her interests include patient advocacy and a passion for providing expert rheumatology consultation to physicians and underserved populations. She is co-author of “Focus on Your Best Health: Smart Guide to the Health Care You Deserve.”