The primary goals of treating ankylosing spondylitis are to reduce inflammation, relieve symptoms, and prevent progression.
NSAIDs reduce inflammation and alleviate back pain with their anti-inflammatory effects.
Treatment strategies, including medication, physical therapy, and lifestyle changes target the cause of inflammation and improve or maintain the function and mobility of the spine and affected joints.
In This Article:
Medications for Ankylosing Spondylitis
Most cases of ankylosing spondylitis require medication therapy to manage inflammation and slow disease progression.
The following tables lists the types of medications used to treat ankylosing spondylitis.
| First-Line Treatments for Ankylosing Spondylitis | Recommendation , | Additional Considerations, |
|---|---|---|
|
Non-steroidal anti-inflammatory drugs (NSAIDs) Eg, naproxen and celecoxib |
Typically, NSAIDs are the first drug prescribed, and moderate doses are utilized (eg, 1000 mg naproxen daily) | Daily use is preferred over intermittent (as-needed) therapy when symptoms are active |
|
Tumor necrosis factor- α inhibitors (TNFi) Eg, Humira and Remicade |
Initiated when NSAIDs are ineffective | If the therapy with a TNFi fails, a second drug in this class is usually recommended |
| Second-Line Treatments for Ankylosing Spondylitis | Recommendation, | Additional Considerations , |
|---|---|---|
|
Interleukin 17 (IL-17) inhibitors Eg, Cosentyx and Taltz |
Recommended after failure of one or more TNFi drugs | Preferred over oral disease-modifying antirheumatic agents (DMARDs) |
|
Janus kinase (JAK) inhibitors Eg, Xeljanz and Rinvoq |
Recommended after failure of one or more TNFi drugs | Preferred over IL-17 inhibitors in patients who also have bowel disease |
|
DMARDs Eg, sulfasalazine and methotrexate |
Typically reserved for ankylosing spondylitis with prominent non-spinal arthritis in the extremities (eg, shoulders and hips) |
Recommended when TNFi therapy is not an option |
Specific treatment recommendations for dosing and combining drug therapies vary depending on whether ankylosing spondylitis symptoms are active or in remission.
See Pain Medications for Arthritis Pain Relief
Duration of medication therapy for ankylosing spondylitis
Ankylosing spondylitis is a chronic condition that, in most cases, requires continued treatment even when the disease is in remission (stable). Continued treatment helps keep inflammation and immune activity in control.,
When the symptoms of ankylosing spondylitis are stable, meaning pain and function are improved and inflammation is controlled, long-term therapy with TNFi or IL-17 inhibitors helps prevent relapse or flare-ups. Drugs such as NSAIDs and DMARDs are not preferred for long-term symptom control due to the potential risk of gastrointestinal and cardiac side effects.,
Physical Therapy and Exercise for Ankylosing Spondylitis
Hip flexor stretches alleviate muscle tension and stiffness in the lower back.
Rehabilitation programs including physical therapy and regular exercise effectively manage pain and improve mobility and flexibility in ankylosing spondylitis. When used with or without medication therapy, physical therapy and exercise have been shown to reduce disease activity and improve function significantly.,
Therapeutic activities recommended for ankylosing spondylitis include,:
- Stretching exercises, such as neck rotation and hip flexor stretches
- Strength training, such as yoga, Pilates, and weight training
- Guided relaxation, such as Tai Chi and deep breathing
- Low-impact aerobic exercises, such as biking or swimming
- Hydrotherapy, including water-based exercises and hydro-electric baths
Routine exercise also aids in increasing lung capacity and improving heart health, which lowers the risk of respiratory and cardiac complications.
Consulting a specialist, such as a physical therapist or occupational therapist, is advisable for individualized exercise plans and to learn the techniques to perform the movements safely and effectively.
Healing Treatments for Ankylosing Spondylitis
Modifying daily habits to sustain a healthy lifestyle enhances the quality of life and reduces the risk of complications in individuals with ankylosing spondylitis. Specific changes include -:
- Anti-inflammatory diet. Incorporating foods with anti-inflammatory properties (eg, whole grains and omega-3 fatty acids) and avoiding or limiting foods that trigger inflammation (eg, alcohol and sugar) helps to improve gut health and relieve symptoms.
- Ergonomic adjustments. Individuals who spend significant time sitting at a desk are encouraged to take breaks, change positions, and stretch regularly.
- Supportive devices. The use of lumbar support pillows, back braces, or zero-gravity chairs helps to reduce pain and promote a supportive posture.
- Smoking cessation. Smoking is associated with an increased risk of respiratory and cardiac conditions. Smoking cessation is advisable to reduce the risk of these complications.
- Weight management. Maintaining a healthy weight reduces the strain placed on joints by excess body weight and decreases the pro-inflammatory cells produced by body fat.
It is also advisable to avoid heavy lifting or strenuous exercises that place an increased strain on the back or other affected joints.
Injection Treatments for Ankylosing Spondylitis
Epidural steroid injections reduce inflammation and control painful symptoms.
Local injections of corticosteroids, such as triamcinolone, are potentially beneficial for patients with sacroiliitis and/or peripheral arthritis who have not responded to oral medications, such as NSAIDs, DMARDs, or biologics.,
Injection treatments offer localized relief from inflammation and pain at the injection site; however, they do not influence the overall disease activity or inflammation in other regions of the body.,
Complementary Treatments for Ankylosing Spondylitis
Several non-drug strategies help reduce stress and inflammation and aid in the management of pain and stiffness in ankylosing spondylitis. These treatments include:
- Spa therapy, including mud packs and thermal (mineral-rich) baths
- Massage therapy, particularly deep-tissue massage
- Acupuncture, which involves the insertion of thin needles into specific points on the body to restore energy flow and reduce pain
- Moxibustion, which involves burning dried mugwort near particular points on the body to stimulate circulation
These treatments are most beneficial when combined with medication and physical therapy.
