Reduced symptoms is just part of the equation.
When you start treatment for ankylosing spondylitis (AS), it’s important to know what to expect. Your doctor should tell you what possible side effects you might experience, or how long it may take before you see improvement in your symptoms. Most importantly, you should know how to tell if your ankylosing spondylitis treatment is working.
There’s no one-size-fits-all approach to treating AS. As a result, you and your doctor will need to work together to find the right option—or options—for you. The first thing you try may or may not be the best fit.
Is Your Treatment Working?
A good treatment should meet your individual goals. In general, this means reduced symptoms and improved quality of life.
“Lack of pain, lack of stiffness in the morning, lack of functional limitations, the ability to do everything that they want to do, are good signs that there’s fair control of the disease,” says Anca D. Askansase, MD, MPH, rheumatologist at Columbia University Irving Medical Center.
Treatment Progression for AS
Many people with AS start with basic over-the-counter pain relievers, such as ibuprofen. These are called nonsteroidal anti-inflammatory drugs, or NSAIDs. This is the recommended approach for anyone with mild to moderate AS symptoms.
“If getting in and out of the car or getting on a treadmill or the bicycle are difficult, … one needs to think about advancing the treatment,” says Dr. Askanase.
When NSAIDs aren’t enough, your doctor might bump you up to disease-modifying antirheumatic drugs (DMARDs). In particular, your doctor may recommend a subtype of DMARDs called biologics. Certain factors may make you a better candidate for biologics, such as having inflammation in your gastrointestinal tract or eyes.
“Depending on the whole picture, the doctor might decide to think about the disease-modifying drugs or about the biologics, and that step should be—and always is—a shared decision,” says Dr. Askanase.
DMARDs have an added benefit of helping to prevent joint deformity and spinal fusion for people with advanced AS. You’ll know your DMARDs are working if they’re successfully stopping or slowing the progression of joint damage.
The good news is that there are many options for treating AS, so if something doesn’t work for you, you might be able to try something else. That’s why it’s important to communicate with your doctor and form a partnership.
“With the new treatments and with a better understanding of the role of physical therapy and constant exercise, we believe … there’s going to be less and less people that have terrible spine damage,” says Dr. Askanase.
Dr. Askanase is a rheumatologist specializing in lupus, Sjogren's syndrome, and vasculitis at Columbia University Irving Medical Center. She is the founder and clinical director of Columbia's Lupus Center and the Director of Rheumatology Clinical Trials.
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If there's persistent pain,
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if waking up in the morning,
there's too much stiffness,
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if getting in and out of the car
or getting on a treadmill
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or the bicycle are difficult, these are all signs
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that the treatment is not enough,
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and one needs to think about advancing the treatment.
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We start with the nonsteroidal anti-inflammatories.
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The doctor might choose to think about
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the disease-modifying drugs, the DMARDs,
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or might choose to think about a biologic.
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And part of those decisions are, how much involvement
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there is in the peripheral joints?
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If there are some other symptoms outside the joints,
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like inflammation in the bowel wall
or inflammation in the eyes?
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For people where there's extensive fusion
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there's the possibility of surgical intervention.
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Spinal fusion is when parts of the spine
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fuse together and become immobile.
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Most people will never have surgery.
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Following the medication regimen,
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following the lifestyle changes
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are very good preventive measures
to the need for surgery.
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Lack of pain, lack of stiffness in the morning,
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lack of functional limitations,
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the ability to do everything that they want to do,
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are good signs that there's fair control of the disease.
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The treatment of ankylosing spondylitis
is a chronic treatment.
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We don't have a cure; we can't fix it overnight.
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It's a long-term commitment.
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With the new treatments
and with a better understanding
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of the role of physical therapy
and constant exercise,
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we believe that that's going to be possible
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and there's going to be less and less people
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that have terrible spine damage.
- Axial spondyloarthritis. Arthritis Foundation. (Accessed on September 14, 2020)
- Clinical manifestations of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. Waltham, MA: UpToDate, 2020)
- DMARDs. Arthritis Foundation. (Accessed on September 14, 2020)
- Treatment of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. Waltham, MA: UpToDate, 2020)