Ankylosing spondylitis (AS) is a type of arthritis that causes inflammation in the joints of the spine, especially the lower spine area. Living with AS means you’ll have at least some pain and stiffness, especially in your lower back, hips, and buttocks.
But you don’t have to settle for days filled with pain. There are a wide range of AS treatments available for you — from medication to physical therapy.
Although these treatments won’t cure your disease, they can prevent further joint damage, and improve your comfort level and flexibility.
There are a variety of medications available to treat AS. Common options include NSAIDs, TNF inhibitors, and steroids.
Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil, Motrin), indomethacin (Tivorbex), and naproxen (Naprosyn) are often the first choice for treating AS.
These drugs do double duty. They relieve pain and reduce inflammation in the spine and other parts of the body. Taking NSAIDs can enable you to stay active and do the exercises that will help keep your joints flexible.
Use NSAIDs with caution, however. Take them only when you need them. These drugs can cause side effects like ulcers and stomach bleeding. Long-term use of these drugs can affect your kidney function.
If NSAIDs don’t relieve your pain, your doctor might recommend a biologic drug called a TNF (tumor necrosis factor) inhibitor. Five TNF inhibitors are FDA-approved to treat AS:
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- etanercept (Enbrel)
- golimumab (Simponi)
- infliximab (Remicade)
These drugs target a substance in the blood called TNF, which promotes inflammation. You’ll receive these medications as an injection under your skin or through an IV.
TNF inhibitors can also cause side effects. Common side effects include burning and itching at the injection site. Serious side effects include an increased risk for developing lymphoma and skin cancers.
These drugs also increase your risk for infections, including tuberculosis (TB) and fungal infections. Before you start treatment, your doctor will test you for TB, as well as hepatitis B and C.
It’s important to update your immunizations before starting treatment with these medications. Speak with your doctor for more information about your specific needs.
If one area — like your hips or knees — is very painful, your doctor may give you a shot of steroids directly into the affected joint. Steroid injections relieve pain and bring down inflammation.
Eye inflammation called iritis or uveitis is a common complication of AS. It can cause vision loss or even blindness if you don’t treat it. See an eye doctor if your eye is red, painful, or sensitive to light.
Your doctor can prescribe steroid eye drops to decrease eye inflammation and treat iritis. Taking a TNF inhibitor will help prevent iritis from coming back in the future.
A physical therapist can teach you exercises to strengthen your muscles and improve your flexibility. You’ll also learn how to improve your posture to avoid putting too much pressure on your spine and aggravating your symptoms.
Some people find that doing these exercises in a pool makes them feel better. But any type of physical therapy is good for AS.
It’s also important for you to exercise regularly at home. Ask your doctor or physical therapist to recommend exercises that are right for you. Make sure to learn how to perform the workouts correctly. It might be helpful for you to follow along with an exercise video designed for people with arthritis.
Do your workout at the time of day when you feel most comfortable. For people whose joints are especially tight in the morning, exercising in the afternoon or evening may be a better option.
Take 5 to 10 minutes to warmup up before you exercise. Walk in place or stretch to loosen up your muscles. Start slowly and never work out to the point of discomfort.
Applying a heating pad or ice pack can feel soothing on sore joints. Heat therapy can help relieve joint stiffness, while cold therapy can reduce swelling and soothe acute pain.
Use whichever one feels best to you, and only apply for short periods of 10 to 15 minutes. Also, be careful not to put anything extremely hot or cold directly on your skin, which could cause a burn.
Eating a particular diet won’t cure AS, but it could help you feel better.
Certain foods are good to eat because of their anti-inflammatory properties. These include fatty fish such as salmon and tuna, nuts like walnuts, and flaxseeds.
If you’re overweight, losing extra weight through portion control and calorie lowering will help take some of the pressure off your painful joints.
Doctors typically don’t recommend surgery for AS. But if you also have severe joint damage from arthritis, you may need a hip or knee replacement to relieve pain and restore your range of motion.
If you have AS, you don’t have to live in pain. Although there is currently no cure for the condition, there are medications, self-care options, and exercises available to help manage symptoms. Talk to your doctor about the best treatment options for you.