Ankylosing spondylitis: Understand your treatment options
Although there's no cure for ankylosing spondylitis — a type of arthritis that affects the spine — treatment can ease your symptoms and possibly slow the progression of the disease.
Ankylosing spondylitis usually starts with pain and stiffness in your back, after times of inactivity. Symptoms typically develop gradually, before age 45, and last more than three months. Pain and stiffness tend to ease with activity but may become ongoing and spread to the neck, ribs, shoulders and heels. When the condition is severe, bones in the spine can fuse together. This can make those parts inflexible, which may stiffen your ribs — making it hard to breathe deeply — or cause a hunched posture.
Ankylosing spondylitis treatment is most successful when started before the disease causes irreversible damage to your joints. Before meeting with your doctor, it may help to understand the treatment options.
Ankylosing spondylitis treatment usually starts with physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs).
- Physical therapy. A physical therapist designs specific exercises for your needs. These exercises can help improve strength. Range-of-motion and stretching exercises can help keep your joints flexible and preserve good posture. Proper sleep and walking positions and abdominal and back exercises can help maintain your upright posture, too.
- NSAIDs. Nonsteroidal anti-inflammatory drugs — such as naproxen (Naprosyn) and indomethacin (Indocin) — can relieve swelling, pain and stiffness. Often, these may be the only medications needed. A potential side effect, however, is bleeding in your stomach or intestines.
If NSAIDs aren't helpful, your doctor might suggest a biologic medication. These could include:
- Tumor necrosis factor (TNF) blockers. TNF blockers help reduce pain, stiffness, and tender or swollen joints. The drug is given as an injection under your skin or through a vein (intravenously). The five TNF blockers approved by the Food & Drug Administration to treat ankylosing spondylitis are: adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi, Simponi Aria) and infliximab (Remicade).
- Interleukin 17 (IL-17) inhibitors. IL-17 also may help ease inflammation and is given as an injection under your skin. Secukinumab (Cosentyx) is the first IL-17 inhibitor approved by the FDA for the treatment of ankylosing spondylitis.
Potential side effects of TNF blockers and IL-17 inhibitors are reactivation of inactive (latent) tuberculosis and an increased risk of infections.
Most people with ankylosing spondylitis don't need surgery. But if you have severe pain or joint damage, or if your hip joint is so damaged that it needs to be replaced, your doctor might recommend surgery.
Sticking with it
Regardless of what treatments you and your doctor choose, it's important to see your doctor often and follow your treatment plan. This can help you avoid complications and worsening of your symptoms and keep your joints working as well as they can.
June 04, 2019
See more In-depth
- Ankylosing spondylitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Ankylosing_Spondylitis. Accessed May 2, 2019.
- Yu DT, et al. Treatment of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. https://www.uptodate.com/contents/search. Accessed May 2, 2019.
- Ward MM, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Care & Research. 2016;68:151.
- AskMayoExpert. Ankylosing spondylitis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
- About spondylitis. Spondylitis Association of America. https://www.spondylitis.org/About-Spondylitis. Accessed May 2, 2019.