Ankylosing spondylitis treatment typically includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs) that can help relieve inflammation, pain and stiffness. Other treatment options may include TNFα blockers and IL-17 inhibitors for patients with persistently high symptoms.
Ankylosing spondylitis (AS) is generally managed by using nonsteroidal anti-inflammatory drugs (NSAIDs) and biologics (tumor necrosis factor alpha (TNFα) blockers and IL-17 inhibitors). Patients who are treated with these drugs have reported improvement in their pain, physical function and morning stiffness. NSAIDs are recommended as the first-line medications and TNFα blockers and IL-17 inhibitors are recommended for patients with persistently high disease activity despite using conventional therapy. Hence, a combination of these drugs may be considered as the best treatment strategy for ankylosing spondylitis.
NSAIDs (nonsteroidal anti-inflammatory drugs) or anti-inflammatory painkillers
- An important reason to take these medicines is to ease the pain so that one can do regular activities and exercises without much discomfort.
- It is thought that anti-inflammatory medicines may not only ease symptoms of AS but may also slow down the progression of the condition.
- There are several different anti-inflammatory medicines, such as ibuprofen, diclofenac and naproxen.
Side effects of NSAIDs
Tumor necrosis factor α (TNFα) blockers or biological medications
They are designed to target specific molecules of the immune system involved in inflammation.
- In ankylosing spondylitis, a chemical called cytokine tumor necrosis factor alpha (TNFα) is involved in causing inflammation, TNFα inhibitors block the action of this chemical.
- As a result, they reduce inflammation and prevent damage to the joints.
- There are several TNFα inhibitors available.
- Secukinumab (This is a new kind of biologic medication that inhibits the inflammatory protein interleukin 17. This drug was recently approved by the FDA for ankylosing spondylitis in patients who weren’t either able to tolerate anti-TNFs or didn’t have a good response from them.)
Side effects of TNFα blockers or biologics
There are risks associated with taking these medicines, and they require special monitoring because some people develop serious side effects, such as:
- Taking these medicines may make people more prone to developing serious infections (including tuberculosis, sepsis and pneumonia).
- Rarely, they may also increase the chance of developing some types of cancer, including lymphoma and leukemia.
However, all of these conditions seem to be much rarer than was initially thought.
Other common treatment options for ankylosing spondylitis
- Injecting steroid medication into an affected joint or muscle can sometimes help treat flare-ups of ankylosing spondylitis symptoms.
- Some people may also need to take a course of steroid tablets or use steroid eye drops in the case of inflammation of the eye.
- Disease-modifying anti-rheumatic drugs, such as methotrexate and sulfasalazine, are sometimes used to treat ankylosing spondylitis when there is pain and inflammation in other parts of the body, such as in the arms or legs, instead of the spine.
- Physiotherapy may also include massage and exercises to improve mobility and relieve pain.
- Sometimes patients may also be recommended for hydrotherapy to help them relax muscles.
- Joint replacement operation or corrective surgery to straighten the spine may sometimes be the only option to treat ankylosing spondylitis.
What is ankylosing spondylitis?
Ankylosing spondylitis (AS) is an autoimmune disease, which primarily affects the bones in the spine (vertebrae) and causes inflammatory back pain. The condition also affects the joints in the shoulders, hips, ribs, heels and other joints. AS causes inflammation of the spinal joints (inter-vertebral joints), leading to severe pain, stiffness and discomfort.
Signs and symptoms of ankylosing spondylitis may include:
- Dull pain in the lower back and back stiffness
- "Flares" of increased pain and stiffness that may last for several weeks in some people
- Limited motion, pain and stiffness in the lower and middle back, hips or neck
- Feeling very tired
- Eyes that are red, irritated or inflamed
- Sensitivity to light
- Problems with balance and mobility
- Trouble breathing
- Impaired vision
Can I get disability benefits for ankylosing spondylitis?
A patient can get disability benefits for ankylosing spondylitis only if the condition is severe and meets the following criteria:
- A confirmation diagnosis from the doctor along with objective evidence of the disease, such as X-rays and laboratory testing.
- A doctor must document in the medical records that the patient has severe symptoms, such as severe pain, stiffness and decreased range of motion in the spine, which prevent a patient from working by restricting their functional capacity to sit, stand, walk, lift or carry.
- A doctor must also document the effect of symptoms on the ability to work by documenting the maximum weight a patient can lift or carry in an eight-hour workday and how long the patient can walk, stand or sit.
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Moon KH, Kim YT. Medical Treatment of Ankylosing Spondylitis. Hip Pelvis. 2014;26(3):129-135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971137/