How is Ankylosing Spondylitis Treated?

Reviewed by: HU Medical Review Board | Last reviewed: June 2022 | Last updated: September 2022

Treatment for ankylosing spondylitis (AS) is tailored to each person since there is a wide variety in how AS affects different people. Treatment for AS aims to achieve several goals, including:1

  • Reducing symptoms, such as pain and stiffness
  • Maintaining spinal flexibility and normal posture
  • Maintaining the person's ability to work and function in daily life
  • Decreasing disease complications

Types of treatments for ankylosing spondylitis

Treating and managing AS usually involves a combination of therapies, including:1,2

Types of surgery

Most people with AS do not need surgery. However, surgery may be needed in some cases. Treatment guidelines recommend using surgery such as hip replacement in people who have advanced hip arthritis. Other surgery that may be needed in some people with AS include:1,2

  • 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), along 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 ACR also recommends ongoing treatment with NSAIDs, rather than only using them during flares. For people who continue to have active disease despite treatment with NSAIDs, the ACR recommends using biologic drugs, like TNF inhibitors. Some people also have success using JAK inhibitors or DMARD medications.1,2

Newer treatment is available with JAK inhibitors.

Treatment with SAARDs is generally not recommended unless a person cannot take TNF inhibitors or cannot tolerate the side effects. Along with drugs, 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.1,2

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, NSAIDs are first recommended. If they do not help to control pain, then biologics may help slow disease progression. Physical therapy is also strongly recommended.1,2

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.1,2

Lifestyle changes

Many people with AS find they must make lifestyle changes to help manage their condition and improve their health and well-being. Lifestyle changes may take many forms, such as:1,2

Complementary therapies

People with AS may also choose to add complementary therapies to their treatment to manage their symptoms. Some complementary medicine approaches for AS include:

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