Along with diet and exercise, these medications may soothe pain.
Ankylosing spondylitis—a chronic and inflammatory arthritis that affects the spine—has no cure as of yet. However, diagnosing AS and beginning treatment is essential. Not only can it relieve the painful and even debilitating symptoms of AS, but it can also help prevent disease progression and deformities.
For example, in advanced cases, people with AS may need surgery to correct the spine or replace joints. To avoid this severe option, doctors recommend early treatment, which includes a combination of medication, lifestyle changes, and physical therapy.
Medications to Treat AS
Here are the medications commonly used to treat AS:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen. These are recommended as the first line of treatment, especially for those with mild AS, according to Jessica Patel, MD, a rheumatologist at Mount Sinai Hospital in New York City. NSAIDs can help reduce inflammation and “can be very effective in improving stiffness as well as pain,” says Dr. Patel.
Analgesics. These are another type of pain reliever that are available by prescription and over the counter (such as Tylenol).
Disease-modifying antirheumatic drugs (DMARDs). For those who don’t find relief from NSAIDs, this class of medications can help alter the course of AS and reduce pain and swelling.
Biologics. These are a type of DMARDs that act on the cells. The biologic that works best for AS is anti-tumor necrosis factor agent, or TNF agent. TNF is an inflammatory substance in the cells, so inhibiting TNF can relieve pain. Other biologics available to treat AS include infliximab, etanercept, adalimumab, and golimumab. “Some [biologics] are injectables, [and] some are infusions, depending on what you need,” says Dr. Patel.
Secukinumab. This is a new kind of biologic that inhibits the inflammatory protein interleukin 17. “Secukinumab … was recently approved [by the FDA] for ankylosing spondylitis in patients who weren’t either able to tolerate anti-TNFs or didn’t have good response to them,” says Dr. Patel.
Corticosteroid injections. This medication is injected into the joint or tendons to combat pain. As the name suggests, this drug mimics the cortisone that’s naturally produced by the body.
Surgery to Treat AS
In some cases, surgery may be necessary if the patient has ankylosis—when the vertebrae of the spine fuses together and the person loses mobility of the spine. “As the disease progresses, and as people get later in life, what can happen is, the bones can fuse together in a position that is not optimal,” says Themistocles Protopsaltis, MD, spine surgeon at NYU Langone Hospital.
Imagine if the spine became “stuck” in an abnormal position, such as with the head stooped forward. “It’s very difficult to go about the daily activities of life if you don’t have good posture [and you’re] leaning forward,” says Dr. Protopsaltis. At this point, you might opt for surgery.
The goal of surgery for AS is to straighten the spine. “The spine often needs to be cut to reset it,” says Dr. Protopsaltis, “and then spears and rods are positioned to maintain that better position for the spine.”
Lifestyle Changes to Treat AS
Although medications can help—especially in severe cases of AS—a healthy lifestyle can assist in minimizing inflammation in the body. “A good regimen with a physical therapist as well as your rheumatologist can really help you ease some of the tensions and pain,” says Dr. Patel.
To reduce inflammation and keep the immune system strong, doctors recommend eating a nutritious and anti-inflammatory diet, not smoking, practicing good posture, doing strength and aerobic exercises, and maintaining a healthy weight.
For treating AS, Dr. Patel recommends stretching and swimming as particularly good exercises. Stretching first thing in the morning—when AS pain tends to be at its worst—can help minimize pain the rest of the day. Swimming works multiple joints and can help with flexibility and mobility of the back. (Consider the way you twist from side to side when doing the front stroke.)
“If you have a diagnosis of ankylosing spondylitis, you can still live a very healthy and functional life,” says Dr. Patel.
00:00:00,000 --> 00:00:01,647
00:00:01,647 --> 00:00:04,754
There's no cure for
ankylosing spondylitis, but
00:00:04,754 --> 00:00:09,450
with the right medication, as well as
lifestyle changes, patients can have
00:00:09,450 --> 00:00:13,801
relief of symptoms and actually
prevent any worsening of the disease.
00:00:13,801 --> 00:00:16,845
00:00:16,845 --> 00:00:22,325
The first line of treatment or even for
milder disease we would recommend NSAIDs
00:00:22,325 --> 00:00:28,484
or non-steroidal anti-inflammatories such
as Iburprofin, or Aleve, or Naproxen.
00:00:28,484 --> 00:00:33,783
And these can be very effective in
improving stiffness as well as pain.
00:00:33,783 --> 00:00:36,901
If individuals are not
able to tolerate those, or
00:00:36,901 --> 00:00:41,443
did not show a good response then we
have other agents such as biologics.
00:00:41,443 --> 00:00:45,610
Biologics used include
00:00:45,610 --> 00:00:49,571
TNFs are actually found in
cells that cause inflammation.
00:00:49,571 --> 00:00:54,922
And some examples include adalimumab,
etanercept or infliximab.
00:00:54,922 --> 00:00:59,167
Some are injectables, some are infusions
depending on what you need.
00:00:59,167 --> 00:01:04,181
The other biologic is actually
interleukin 17, which is a cytokine that
00:01:04,181 --> 00:01:09,038
also causes inflammation and
this medication is called Secukinumab and
00:01:09,038 --> 00:01:14,293
it was recently approved for ankylosing
spondylitis in patients who weren't
00:01:14,293 --> 00:01:19,404
either able to tolerate anti-TNFs or
didn't have a good response to them.
00:01:19,404 --> 00:01:25,519
So along with all of this physical therapy
as well as exercise is really crucial.
00:01:25,519 --> 00:01:28,924
And a good regimen with
a physical therapist as well
00:01:28,924 --> 00:01:33,674
as your rheumatologist can really help
you ease some of the tensions and
00:01:33,674 --> 00:01:37,726
pain when it comes to the stiffness
of the joints in the back.
00:01:37,726 --> 00:01:41,730
Stretching exercises that can
help with the flexibility and
00:01:41,730 --> 00:01:43,779
mobility of the spine are key.
00:01:43,779 --> 00:01:48,487
Often times the morning is the worst in
patients with ankylosing spondylitis.
00:01:48,487 --> 00:01:53,701
So starting off doing some stretching
exercises can set you off pretty good for
00:01:53,701 --> 00:01:55,048
the rest of the day.
00:01:55,048 --> 00:01:59,220
Along with stretching exercises,
swimming can be very helpful,
00:01:59,220 --> 00:02:02,423
because it really uses multiple joints,
00:02:02,423 --> 00:02:06,816
with flexibility of the back as well.
Surgery wouldn't be necessary in
00:02:06,816 --> 00:02:09,371
the initial, early stages of the disease.
00:02:09,371 --> 00:02:13,625
So a younger man, or
a younger woman wouldn't necessarily need
00:02:13,625 --> 00:02:17,248
to go right to some kind of
joint replacement surgery or
00:02:17,248 --> 00:02:20,270
spine fusion surgery
in the initial stages.
00:02:20,270 --> 00:02:24,429
But as the disease progresses and
as patients get later in life,
00:02:24,429 --> 00:02:30,062
what can happen is that the bones confused
together in a position that's not optimal.
00:02:30,062 --> 00:02:34,744
So in a case of the spine,
if the bones fuse and patient is leaning
00:02:34,744 --> 00:02:39,778
forward that's very difficult to go
about of the daily activities of
00:02:39,778 --> 00:02:44,672
life if you don't have good posture and
you're leaning forward.
00:02:44,672 --> 00:02:49,466
And at a certain point it becomes
difficult to do those activities of daily
00:02:49,466 --> 00:02:55,048
living, to enjoy life, and they come to a
decision that surgery might be necessary.
00:02:55,048 --> 00:02:59,457
And surgery usually involves
straightening the spine, and so
00:02:59,457 --> 00:03:04,045
because the disorder can ankylose
the spine and lock it in place.
00:03:04,045 --> 00:03:08,554
The spine often needs to be cut
to reset it, and then screws and
00:03:08,554 --> 00:03:12,721
rods are positioned to maintain
that better position for
00:03:12,721 --> 00:03:15,978
If you have a diagnosis of ankylosing
00:03:15,978 --> 00:03:20,337
spondylitis you can still live
a very healthy and functional life.
00:03:20,337 --> 00:03:24,911
We have a much better understanding of
diagnosis and treatment today then we did
00:03:24,911 --> 00:03:29,554
before, and there are other medications
being studied specially biologics for
00:03:29,554 --> 00:03:33,531
ankylosing spondylitis and
other inflammatory arthritis as well.
00:03:33,531 --> 00:03:38,196
Ankylosing spondylitis self-care. Atlanta, GA: Arthritis Foundation. https://www.arthritis.org/about-arthritis/types/ankylosing-spondylitis/self-care.php.)
Ankylosing spondylitis treatment. Atlanta, GA: Arthritis Foundation. https://www.arthritis.org/about-arthritis/types/ankylosing-spondylitis/treatment.php.)
How is ankylosing spondylitis treated? Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases. (Accessed on September 20, 2018 at https://www.niams.nih.gov/health-topics/ankylosing-spondylitis#tab-treatment.)
Patient education: axial spondyloarthritis, including ankylosing spondylitis (beyond the basics). Waltham, MA: UpToDate. (Accessed on September 20, 2018 at https://www.uptodate.com/contents/axial-spondyloarthritis-including-ankylosing-spondylitis-beyond-the-basics.)
Patient education: disease-modifying antirheumatic drugs (DMARDs)(beyond the basics). Waltham, MA: UpToDate. (Accessed on September 20, 2018 at https://www.uptodate.com/contents/disease-modifying-antirheumatic-drugs-dmards-beyond-the-basics.)