Treatment for Ankylosing Spondylitis: New Options That Can Help

Along with diet and exercise, these medications may soothe pain.

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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.