How is Ankylosing Spondylitis Treated?
Treatment for ankylosing spondylitis (AS) is tailored to the individual, as there is a wide variety in how AS affects different people. Treatment for AS aims to achieve several goals, including1:
Types of treatments for ankylosing spondylitis
Treating and managing AS usually involves a combination of therapies, including:
- Non-steroidal anti-inflammatory drugs (NSAIDs) - widely used medications for pain and inflammation
- Biologic medications - therapies made from living organisms and designed to target specific aspects of the inflammatory process, such as tumor necrosis factor (TNF) and interleukin 17-A (IL-17A)
- Corticosteroids - medications that mimic the body's natural hormone of cortisol and reduce inflammation
- Slow-acting anti-rheumatic drugs, (SAARDs)/also called disease-modifying anti-rheumatic drugs (DMARDS) - drugs which reduce inflammation and have typically been used to treat inflammatory arthritis conditions
- Physical therapy
- Regular exercise
- Surgery, if needed
Types of surgery
While most people with AS don't need surgery, in certain cases surgery may be necessary. The ACR guidelines recommend using surgery such as hip replacement in people who have advanced hip arthritis.1 Other surgeries that may be needed in certain people with AS include2:
- Osteotomy - used to correct a deformity in the spine
- Spinal fusion instrumentation - used to stabilize a weakened spine
- Spinal decompression - used to relieve pressure on the nerves
General treatment recommendations
The American College of Rheumatology (ACR), in conjunction with the Spondylitis Association of America and the Spondyloarthritis Research and Treatment Network, have created treatment guidelines for AS. NSAIDs are recommended as a first-line treatment (the first treatment tried), and the ACR recommends ongoing treatment with NSAIDs, rather than only using NSAIDs during flares. For people who continue to have active disease despite treatment with NSAIDs, the ACR recommends using biologic medications, like TNF (tumor necrosis factor) inhibitors.
Treatment with SAARDs are generally not recommended, unless the individual cannot take TNF inhibitors or cannot tolerate the side effects. In addition to medications, people with AS are advised to do regular exercise, including posture exercises. Physical therapy is recommended to help manage the symptoms of the disease and help people living with AS maintain their ability to move.
Treatment recommendations for active versus stable ankylosing spondylitis
Treatment guidelines by the ACR recommend different approaches for people who have active AS and those whose disease is stable. For active AS, first NSAIDs are recommended. If they do not help to control pain, then biologics may help slow disease progression. Physical therapy is also strongly recommended.
For stable AS, the ACR conditionally recommends continuing treatment with TNF inhibitors alone, instead of both NSAIDs and TNF inhibitors. For those taking SAARDs and TNF inhibitors with stable disease, the ACR also conditionally recommends continuing treatment with TNF inhibitors alone. Physical therapy should be continued for both active and stable AS.
Many people with AS find they must make modifications to their lifestyle to help manage their condition and maximize their health and well-being. Lifestyle changes may take many forms, such as:
- Quitting smoking
- Regular physical activity
- Daily stretching
- Stress management
- Recognizing and respecting personal limits
- Building a support team
People with AS may also choose to incorporate complementary therapies along with their treatment to manage their symptoms. Some of the complementary medicine approaches for AS include: