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Treatment of Ankylosing Spondylitis and Related Diseases

A common treatment regimen for the various forms of spondyloarthritis (ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, reactive arthritis, juvenile spondyloarthritis, and undifferentiated spondyloarthritis) involves medication, exercise, physical therapy, good posture practices, and other options such as applying heat/cold to help relax muscles and reduce joint pain. In severe cases, posture correcting 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), medications may need to be adjusted so the gastrointestinal component of the disease is also treated and not exacerbated.

The updated 2019 Recommendations for the Treatment of Ankylosing Spondylitis (AS) and Nonradiographic Axial Spondyloarthritis (nr-axSpA) are now available. The guidelines includes 86 recommendations that provide updated and new guidance for the management of patients with AS and nr-axSpA in the areas of pharmacologic and non-pharmacologic treatment options; AS-related comorbidities; and disease activity assessment, imaging, and screening. The update addressed only a subset of treatment questions. The 2015 recommendations that were not reexamined are to be considered extant.

Updated 2019 Treatment Guidelines

In September of 2015 the first ever treatment guidelines for U.S. physicians in ankylosing spondylitis and non-radiographic axial spondyloarthritis were released by the American College of Rheumatology (ACR) and include “specific, actionable recommendations that clinicians could readily apply in their practices” to better serve the patient.

Both the original and the 2019 update to the guidelines were developed in partnership with the Spondylitis Association of America (SAA) and the Spondyloarthritis Research & Treatment Network (SPARTAN). These huge accomplishments wouldn’t have been possible without the generous donations of our members and donors, as SAA provided the foundation funding for this undertaking, insisted that patients were active participants in the process, and has been closely involved in the projects.

For more information visit the American College of Rheumatology / Spondylitis Association of America / Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthritis

2015 Treatment Guidelines

SAA receives no government funding and relies on the generous donations from individuals to create and maintain the programs and services aimed at improving the futures of the 2.7 million Americans affected by spondylitis.


There are a number of different types and classes of medications used in the treatment of ankylosing spondylitis and related diseases. Note that different people respond to different medications with varying levels of effectiveness. Thus, it may take time to find the most effective course of treatment.

About Medications

Exercise & Posture

Exercise is an integral part of any spondylitis program. Fitting exercise into your day can be tough, but it needs to be done. Exercise is such a high priority that you must make time for it each day (even five to10 minutes during a work break is helpful). If you do, many benefits will follow from your efforts. A spondylitis exercise program will help you maintain good posture, flexibility and eventually help to lessen pain.

About Exercise & Posture

Diet & Nutrition

In recent years, many specialized diets have gained popularity among some people with arthritis. To date, few of these claims have been substantiated by rigorously controlled studies. That said, some people find that certain foods trigger changes in symptoms –– either for the better or the worse. If you find yourself noticing this type of pattern, try keeping a food diary for a few weeks to test if indeed what you eat makes a difference or if you have food sensitivities.

About Diet & Nutrition

Complementary Treatments

The National Institutes of Health defines complementary and alternative medicine (CAM) as a group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine. CAM therapies used alone are often referred to as "alternative." When used in addition to conventional medicine, they may be referred to as "complementary.” The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge.

About Complementary Treatments

Stress Reduction

Many people with spondylitis state that stress reduction is important to their ability to manage pain. Stress and anxiety can exacerbate symptoms, including contributing to an increase in pain. There are several modalities available to manage stress including medications, counseling, meditation, breathing techniques, tai chi, yoga, being in nature, massage, etc.

For further reading see Anxiety and Pain by Dr. Glassman Spondylitis from our Winter 2010 issue of Spondylitis Plus and our book, Straight Talk on Spondylitis.


Applying heat to stiff joints and tight muscles can help reduce pain and soreness. Applying cold to inflamed areas can help reduce swelling and muscle inflammation. Hot baths and showers can also help provide relief.


In severe cases of spondyloarthritis, surgery can be an option, especially hip joint replacement. Surgical correction is also possible for those with severe kyphosis (severe downward curvature) of the spine, particularly in the neck, although this procedure is considered risky.

Related Resources

Spondylitis Plus

New Spondyloarthritis Treatment Guidelines

Posted December 2015

In September of this year the American College of Rheumatology released the first ever recommendations for physicians in the US for the treatment of ankylosing spondylitis and non-radiographic axial spondyloarthritis.  

Read more…

Troubleshooting Spondylitis: Complications and Comorbidities

Posted February 2016

Watch as noted rheumatologist Lianne Gensler, MD explains possible complications and comorbidities associated with spondylitis, including common issues—such as fatigue, uveitis, and osteoporosis—as well as rare complications.

Read more…

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