Treatment Options for Ankylosing Spondylitis

By

Grant Louie, MD, MHS

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Ankylosing spondylitis (AS) is a progressive inflammatory disease that affects vertebrae in the spine and often the hip, knee, and shoulder joints. It can also lead to other issues such as uveitis (eye inflammation) and inflammatory bowel disease (IBD). Although AS is a chronic condition, the good news is that there are many options available to treat the disease and help patients live full, active lives.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Daily NSAIDs are the first line of treatment to reduce inflammation, pain, and stiffness.  NSAIDs, such as ibuprofen (Advil, Motrin) and certain doses of naproxen (Aleve) are available over the counter. Stronger versions of NSAIDs such as celecoxib (Celebrex) and diclofenac (Voltaren) are available by prescription. For some patients, taking NSAIDs can be a very effective therapy, in addition to daily exercise. But, not all patients respond to these medications, and some can’t take them due to stomach distress or other side effects, so be sure you discuss this with your healthcare provider.

Physical Therapy and Exercise

Many of my patients underestimate the importance of physical therapy and daily exercise. I always try to emphasize how important exercise and physical therapy sessions are when it comes to increasing flexibility and mobility, reducing pain, and improving overall health. Cardiovascular exercise and strength training can help patients achieve a healthy weight while building lean muscle. This combination helps relieve stress and pressure on your joints, reducing inflammation that can lead to AS.

Disease-Modifying Antirheumatic Drugs (DMARDs)

Some patients experience less spine inflammation and instead suffer more from secondary ankylosing spondylitis symptoms like arthritis of the hip, knee, or shoulder. For these patients, I prescribe DMARDs, a class of drugs that reduce inflammation and prevent or reduce joint pain and damage. These drugs work by halting the immune system’s attack, or inflammatory response, on the joints The DMARD I typically prescribe is sulfasalazine (Azulfidine). Methotrexate (Rheumatrex) is another DMARD option for treating AS, although there is much less data regarding its effectiveness to support its use as first-line therapy.

Corticosteroids

When NSAIDs and DMARDs are not effective or strong enough to relieve the pain, I may inject a corticosteroid shot directly into the inflamed joint. These types of shots can quickly reduce inflammation and, most importantly, provide pain relief. A shot directly into the sacroiliac (SI) joint (the joint that connects the base of your spine to your pelvis) can ease pain and stiffness quickly. While these types of shots can provide fast relief, they are not used as a long-term solution because of the potential for adverse side effects, such as high blood pressure, cataracts, and osteoporosis.

Biologics

Biological agents, or biologics, are a type of drug that doctors use to treat spinal inflammation, secondary joint inflammation and associated conditions, such as Crohn’s disease, an inflammatory bowel disease. These medications work by suppressing the immune system to block the production of proteins in the body that cause inflammation. One type of biologic is called a TNF inhibitor because it blocks a protein called tumor necrosis factor (TNF). The drugs in this class are administered by injection or by intravenous infusion (IV). The five TNF inhibitor medications approved by the U.S. Food and Drug Administration (FDA) to treat AS are:



THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.


Grant Louie, MD, MHS

Grant Louie, MD, MHS, is associate director of the Spondyloarthritis Program at the Johns Hopkins Arthritis Center. He’s also assistant professor of medicine in the Johns Hopkins Division of Rheumatology. View his Healthgrades profile >

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