Ankylosing spondylitis is a chronic, inflammatory autoimmune disease. It is a rare form of arthritis that mainly affects the sacroiliac joints between the bones of the pelvis, and the axial skeleton, which includes the spinal column, ribcage, neck, and skull bones.
The prognosis for ankylosing spondylitis varies widely, with some patients only experiencing mild symptoms and minimal progression, to about 20 to 30 percent of patients who have serious symptoms and significant progression.
It is possible to live a long life with ankylosing spondylitis. Life expectancy for people who have ankylosing spondylitis is the same as that of the general population, except for patients who have the most severe forms of the disease and for those who have complications.
While ankylosing spondylitis isn’t life-threatening in itself, complications and comorbidities associated with the condition may be.
Complications of ankylosing spondylitis that may affect life expectancy include:
Factors that may indicate a poorer outcome with ankylosing spondylitis include:
- Developing ankylosing spondylitis at a younger age, such as childhood or adolescence
- Hip involvement
- Nonsteroidal anti-inflammatory drugs (NSAIDs) don’t work to control pain
- Limited mobility in the lower spine (lumbar spine)
- If the erythrocyte sedimentation rate (ESR or sed rate) is elevated
- ESR is a type of blood test
- ESR is an indicator of inflammation in the body
- If other conditions such as psoriasis or irritable bowel disease (IBD) are also present
What Is the Treatment for Ankylosing Spondylitis?
Treatment for ankylosing spondylitis may involve a combination of medication, exercise, physical therapy, good posture practices, applying heat/cold to help relax muscles and reduce joint pain, and surgery in severe cases.
Medications used to treat ankylosing spondylitis include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and stiffness (most commonly used)
- Sulfasalazine (a DMARD) and methotrexate for arthritis symptom relief are recommended when NSAIDs do not work
- Tumor necrosis factor-α (TNF-α) antagonists such as infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab pegol (Cimzia), and golimumab (Simponi), may help improve symptoms
- Anti-interleukin 17 therapy such as secukinumab (Cosentyx) and ixekizumab (Taltz) may be used in place of anti-TNF therapy
- Corticosteroid injections for swollen, painful joints or an inflamed tendon or bursa or the sacroiliac joints (oral corticosteroids are not used)
- Opioids (narcotics) for pain
Physical therapy and exercise are integral parts of treatment for ankylosing spondylitis to help maintain good posture and flexibility and to decrease pain. Other treatments for ankylosing spondylitis may include:
- Core strengthening
- Isometric strengthening
- Breathing exercises
- Dynamic movements
- Fall-prevention exercises
- Posture training to help prevent the spine from becoming “frozen”
- Safety measures to minimize accidents caused by limited mobility
- Heat or cold therapy
- Transcutaneous electrical nerve stimulation (TENS)
- Support groups to help patients cope
Surgery may be used to treat severe cases of ankylosing spondylitis and may include:
- Spinal surgery to fuse the bones in the cervical or upper thoracic spine
- Wedge osteotomy to remove a piece of bone from a spinal bone (vertebra), followed by a realignment of the spine which is braced to heal in a better position
- Total hip replacement for severe, chronic hip pain and limited mobility
- Fracture stabilization
Health Solutions From Our Sponsors