Ankylosing spondylitis is a rare form of arthritis and is a chronic, inflammatory autoimmune disease. It 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.
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.
The best treatment for ankylosing spondylitis depends on the type of spondyloarthritis, symptoms, and severity of the condition
Ankylosing Spondylitis Medications
Medications used to treat ankylosing spondylitis include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and stiffness
- NSAIDs are the most commonly used type of medication to treat ankylosing spondylitis
- When NSAIDs do not work, sulfasalazine (a DMARD) and methotrexate for arthritis symptom relief are recommended
- 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 for Ankylosing Spondylitis
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:
- Isometric strengthening
- Core 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 for Ankylosing Spondylitis
Surgery may be used to treat severe cases of ankylosing spondylitis and may include:
- Total hip replacement for severe, chronic hip pain and limited mobility
- Fracture stabilization
- 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 realignment of the spine which is braced to heal in a better position
What Are Symptoms of Ankylosing Spondylitis?
Symptoms of ankylosing spondylitis often start in late adolescence or early adulthood, and can include:
- Pain and stiffness in the lower back and buttocks
- Mild fever (early stage)
- Loss of appetite (early stage)
- General discomfort (early stage)
- Irritation of soft tissues (muscles, ligaments, tendons) where they enter the bones (enthesitis), particularly in extremities
- Bowel inflammation, which may be associated with Crohn’s disease or ulcerative colitis
- Eye inflammation (uveitis or iritis)
- Blurred vision
- Painful, watery, red eyes
- Sensitivity to bright light
- Stooped posture (advanced stage)
What Causes Ankylosing Spondylitis?
It is not known what causes ankylosing spondylitis but it is believed a combination of genetic and environmental factors plays a role.
Risk factors for ankylosing spondylitis include:
- Family history of ankylosing spondylitis
In people with a genetic predisposition, triggers for ankylosing spondylitis may include:
How Is Ankylosing Spondylitis Diagnosed?
Ankylosing spondylitis is diagnosed with a patient history and physical examination in which the doctor will check for inflammatory back pain and irritation of soft tissues (muscles, ligaments, tendons) where they enter the bones (enthesitis), or arthritis.
Tests used to diagnose ankylosing spondylitis include:
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