Conventional Treatments for Ankylosing Spondylitis (AS)

What is ankylosing spondylitis (AS)?

Ankylosing spondylitis (AS) — a form of arthritis — is a chronic, inflammatory condition that most commonly surfaces in late adolescence or early adulthood. AS primarily affects the lower portion of the spine; however, other large joints, such as the hips, shoulders or knees, may be involved as well. In severe cases, bodily organs, such as the lungs, heart, eyes or kidneys, may also be affected.

Conventional treatment options

Treatment options for ankylosing spondylitis focus on relieving pain and stiffness while also preventing or delaying deformities of the spine. No known cure for ankylosing spondylitis exists today. However, there is hope. Early diagnosis is critical; treatments for managing the condition reduce inflammation which can prevent AS complications.

Medications

Medication options for ankylosing spondylitis include, but are not limited to, the following:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as over-the-counter ibuprofen or naproxen, can reduce pain symptoms and stiffness. If symptoms are severe, a stronger NSAID may be prescribed, such as indomethacin, diclofenac or celecoxib. Although NSAIDs may reduce inflammation, pain and stiffness, they may also cause gastrointestinal bleeding. A health care provider should be consulted regarding NSAID dosage to prevent any complications.
• Analgesics, such as over-the-counter acetaminophen or a prescribed opioid analgesic (e.g., tramadol) may be used to reduce symptoms of ankylosing spondylitis.
• Corticosteroid injections work to reduce inflammation.
• Disease-modifying antirheumatic drugs (DMARDs) may be prescribed if ankylosing spondylitis symptoms do not respond to NSAIDs. A DMARD, such as sulfasalazine, can reduce swelling and pain, as well as alter the course of AS.
• Tumor necrosis factor (TNF) inhibitors are biologic DMARDs. Although there are several forms of biologics, TNF blockers have proven to work best for the treatment of ankylosing spondylitis. TNF inhibitors reduce painful, stiff, tender and swollen joints by blocking a cell protein that causes inflammation. It is injected under the skin or via an intravenous line. Adalimumab, certolizumab pegol, etanercept, golimumab and infliximab are TNF blockers that are currently approved by the U.S. Food and Drug Administration (FDA) to treat ankylosing spondylitis.
• Interleukin-17 (IL-17) inhibitors, such as secukinumab or ixekizumab, are also biologic DMARDs that help to reduce inflammation and protect the body from infection.
• Steroid eye drops may be prescribed if inflammation of the eye develops.

Physical Therapy

Physical therapy can help decrease pain while improving strength and flexibility. A physical therapist can provide specific exercises tailored for individuals with ankylosing spondylitis. Physical therapy helps improve posture through stretching, abdominal and back exercises, and range-of-motion exercises. Learning proper walking and sleeping positions is also important to maintain an upright posture.

Surgery

Most cases of ankylosing spondylitis do not require surgery. However, joint replacement surgery may be needed in cases of AS with severe pain or joint damage.