Treatment for Ankylosing Spondylitis
Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.
What is the latest treatment for ankylosing spondylitis? Would using lasers to remove the osteophytes be a possible way of restoring flexibility to the spine?
Ankylosing spondylitis is a joint disease. There is inflammation of the sacroiliac joints, and joints in the spine (spondylitis) and the arms and/or legs. Typically, the disease begins in early adulthood. It is more common in young men than women.
The inflammation affects the sacroiliac joints first. Morning stiffness in the lower back is typical. Over time there may be stiffness that involves the entire spine. Eventually, the mobility of the lower back is severely limited. X-rays may show that bone has grown between the spinal bones (also called ankylosis, or fusion), making spine motion nearly impossible.
Some traditional treatments include:
Anti-inflammatory drugs (such as ibuprofen)
- Medicine that alters the body's immune and inflammation systems (including methotrexate and sulfasalazine). These drugs are most helpful for arthritis in the joints of the arms or legs (such as wrist or ankle) rather than spinal joint inflammation.
Newer drugs approved for treatment include adalimumab, etanercept, golimumab and infliximab. They can be highly effective. And they may even prevent or slow the loss of spine flexibility.
Osteophytes are bony outgrowths typical of osteoarthritis, not ankylosing spondylitis. So treatment directed toward osteophytes would not be expected to be helpful in this disease.
I am not aware of any role for laser treatment. Or of any studies that have carefully evaluated its ability to improve flexibility in this condition. A review of the medical literature reveals almost no mention of this approach for ankylosing spondylitis.
Studies involving a small number of patients in the mid-1980s (published in Russian with summaries in English) found promising results. One study mentioned that "external helium-neon laser therapy of the vertebral column and joints" produced "a certain therapeutic effect." However, the lack of details or a more recent published experience suggests that this approach doesn't produce lasting effects. Or laser was not nearly as effective as the newer therapies.
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