Treatment of Ankylosing Spondylitis & Related Diseases
A common treatment regimen for all the spondyloarthropathies (ankylosing spondylitis, reactive arthritis, psoriatic arthritis, enteropathic arthritis, and undifferentiated spondyloarthropathy) involves medication, exercise and possibly physical therapy, good posture practices, and other treatment options such as applying heat/cold to help relax muscles and reduce joint pain. In severe cases of ankylosing spondylitis, surgery may also be an option.
Depending on the type of spondyloarthritis, there may be some variation in treatment. For example, in psoriatic arthritis, both the skin component and joint component must be treated. In enteropathic arthritis (spondylitis/arthritis associated with inflammatory bowel disease such as Crohn's or ulcerative colitis), medications may need to be adjusted so the gastrointestinal component of the disease is not exacerbated.
Thanks to the individual membership support of the SAA, there are physician recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Published In September 2015, for the first time there are "specific, actionable recommendations that clinicians could readily apply in their practice". Click here for more information: ACR/SAA/SPARTAN Treatment Guidelines
NSAIDs (nonsteroidal anti-inflammatory drugs) are still the cornerstone of treatment and the first stage of medication in treating the pain and stiffness associated with spondylitis. However, NSAIDs can cause significant side effects, in particular, damage to the gastrointestinal tract.
When NSAIDs are not enough, the next stage of medications, (also known as second line medications), are sometimes called disease modifying anti-rheumatic drugs (DMARDS). This group of medications include: Sulfasalazine, Methotrexate and Corticosteroids.
The most recent and most promising medications for treating ankylosing spondylitis are the biologics, or TNF Blockers. These drugs have been shown to be highly effective in treating not only the arthritis of the joints, but also the spinal arthritis. Included in this group are Enbrel, Remicade, Humira and Simponi. Click here to learn more in the medications section
Exercise in an integral part of any spondylitis management program. Regular daily exercises can help create better posture and flexibility as well as help lessen pain.
A properly trained physical therapist with experience in helping those with ankylosing spondylitis can be a valuable guide in regard to exercise. Click here to learn more about exercise.
Practicing good posture techniques will also help avoid some of the complications of spondylitis including stiffness and flexion deformities / kyphosis (downward curvature) of the spine. Click here to learn more about posture
Applying heat to stiff joints and tight muscles can help reduce pain and soreness. Applying cold to inflamed areas can help reduce swelling. Hot baths and showers can also help provide relief.
In severe cases of ankylosing spondylitis, surgery can be an option in the form of joint replacements, particularly in the knees and hips. Surgical correction is also possible for those with severe flexion deformities (severe downward curvature) of the spine, particularly in the neck, although this procedure is considered risky.
Other Symptom Management Tools
Alternative treatments such as massage and using a TENS unit (electrical stimulators for pain) can also aide in pain relief. Maintaining a healthy body weight and balanced diet can also aide in treatment. Click here for more information on alternative treatments.