What are the most effective treatments for ankylosing spondylitis. How can exercise and physiotherapy help manage AS symptoms. What medications are used to treat ankylosing spondylitis. How do biological treatments and JAK inhibitors work for AS. What role do corticosteroids play in managing ankylosing spondylitis.

Understanding Ankylosing Spondylitis: A Chronic Inflammatory Condition

Ankylosing spondylitis (AS) is a chronic inflammatory condition that primarily affects the spine and sacroiliac joints. While there is currently no cure for AS, various treatment options are available to manage symptoms, improve quality of life, and potentially slow disease progression. This comprehensive guide explores the multifaceted approach to treating ankylosing spondylitis, combining non-pharmacological and pharmacological interventions.

What is the primary goal of ankylosing spondylitis treatment?

The main objectives of AS treatment are to:

• Relieve pain and stiffness
• Maintain spinal flexibility and good posture
• Prevent or delay spinal fusion
• Reduce inflammation
• Improve overall function and quality of life

The Crucial Role of Exercise and Physiotherapy in AS Management

Exercise and physiotherapy form the cornerstone of ankylosing spondylitis treatment. Regular physical activity can significantly improve posture, spinal mobility, and overall well-being for individuals with AS.

How does exercise benefit people with ankylosing spondylitis?

Exercise offers numerous benefits for AS patients:

• Improves flexibility and range of motion
• Strengthens muscles supporting the spine
• Reduces pain and stiffness
• Enhances cardiovascular health
• Boosts mood and mental well-being

What types of exercises are recommended for AS patients?

A comprehensive exercise program for AS typically includes:

1. Stretching exercises
2. Strengthening exercises
3. Aerobic activities
4. Posture training
5. Balance and coordination exercises

Physiotherapists play a crucial role in designing tailored exercise programs for individuals with AS. They can provide guidance on proper techniques, recommend suitable exercises, and monitor progress over time.

Can hydrotherapy be beneficial for AS patients?

Yes, hydrotherapy or aquatic exercises can be particularly beneficial for individuals with AS. The buoyancy of water reduces stress on joints while providing resistance for muscle strengthening. The warmth of the water can also help relax muscles and ease pain. Many AS patients find hydrotherapy to be a comfortable and effective form of exercise.

Pharmacological Interventions: Managing Pain and Inflammation in Ankylosing Spondylitis

While exercise and physiotherapy are essential, medications play a crucial role in managing pain, reducing inflammation, and potentially slowing disease progression in ankylosing spondylitis.

What are the first-line medications for AS treatment?

Non-steroidal anti-inflammatory drugs (NSAIDs) are typically the first-line medication for AS. They help reduce pain and inflammation, improving symptoms and function. Common NSAIDs used in AS treatment include:

• Ibuprofen
• Naproxen
• Diclofenac
• Etoricoxib

It’s important to note that while NSAIDs can be effective, they may cause side effects, particularly with long-term use. Healthcare providers will work to find the most suitable NSAID and the lowest effective dose for each individual.

Are there alternative pain management options for AS?

For individuals who cannot tolerate NSAIDs or require additional pain relief, alternative options may include:

• Paracetamol (acetaminophen)
• Codeine (in some cases)

These medications can help manage pain but do not address the underlying inflammation associated with AS.

Advanced Therapies: Biological Treatments for Ankylosing Spondylitis

When conventional treatments prove insufficient, biological therapies may be considered for managing ankylosing spondylitis. These advanced medications target specific components of the immune system involved in the inflammatory process.

How do anti-TNF medications work in treating AS?

Anti-tumor necrosis factor (anti-TNF) medications are a type of biological therapy used in AS treatment. They work by blocking the effects of TNF, a protein that plays a key role in inflammation. By reducing TNF activity, these medications can significantly decrease inflammation in the joints and spine, alleviating symptoms and potentially slowing disease progression.

Anti-TNF medications are typically administered via injection and may be recommended for patients whose symptoms are not adequately controlled with NSAIDs and exercise. However, it’s important to note that these medications can affect the immune system, potentially increasing the risk of infections.

What other biological treatments are available for AS?

In addition to anti-TNF medications, other biological treatments for AS include:

• Interleukin-17 (IL-17) inhibitors: Secukinumab and ixekizumab
• Interleukin-23 (IL-23) inhibitors: Ustekinumab

These medications work by targeting different inflammatory pathways involved in AS. They may be offered to patients who do not respond to or cannot tolerate anti-TNF therapy.

Emerging Therapies: JAK Inhibitors in Ankylosing Spondylitis Treatment

Janus kinase (JAK) inhibitors represent a newer class of medications that have shown promise in treating ankylosing spondylitis. These oral medications work by blocking specific enzymes involved in the inflammatory process.

How do JAK inhibitors benefit AS patients?

JAK inhibitors, such as upadacitinib, offer several potential benefits for AS patients:

• Reduce inflammation and pain
• Improve physical function
• Convenience of oral administration
• Potential alternative for patients who don’t respond to or cannot use anti-TNF therapy

As with all medications, JAK inhibitors can have side effects and require careful monitoring by healthcare providers. They represent an important addition to the treatment arsenal for AS, particularly for patients with limited options.

The Role of Corticosteroids in Managing Ankylosing Spondylitis

Corticosteroids, potent anti-inflammatory medications, can play a role in managing acute flares or specific joint inflammation in ankylosing spondylitis. However, their use is generally limited due to potential long-term side effects.

When are corticosteroids used in AS treatment?

Corticosteroids may be used in AS management in the following scenarios:

• For short-term relief during acute flares
• As local injections for inflamed joints
• In cases where other treatments have not been effective

When corticosteroids are injected directly into an inflamed joint, patients are typically advised to rest the joint for up to 48 hours post-injection to maximize the benefits and minimize potential side effects.

Holistic Approach: Combining Treatments for Optimal AS Management

Effective management of ankylosing spondylitis often requires a multifaceted approach, combining various treatment modalities to address different aspects of the condition.

How can different treatments be combined for better AS management?

A comprehensive AS treatment plan may include:

• Regular exercise and physiotherapy
• Medications (NSAIDs, biologics, or JAK inhibitors)
• Pain management strategies
• Lifestyle modifications (e.g., posture awareness, stress management)
• Regular monitoring and follow-up with healthcare providers

The specific combination of treatments will vary for each individual based on their symptoms, disease severity, and response to different interventions. Regular communication with healthcare providers is crucial to adjust the treatment plan as needed and ensure optimal management of AS.

Living with Ankylosing Spondylitis: Beyond Medical Interventions

While medical treatments are crucial in managing AS, lifestyle factors and self-management strategies play a significant role in improving quality of life for individuals with this condition.

What lifestyle modifications can help manage AS symptoms?

Several lifestyle changes can complement medical treatments and help manage AS:

• Maintaining good posture
• Using proper body mechanics when lifting or carrying objects
• Quitting smoking (smoking is associated with more severe AS)
• Managing stress through relaxation techniques or mindfulness practices
• Ensuring adequate sleep and rest
• Maintaining a healthy diet and weight

Additionally, joining support groups or connecting with other AS patients can provide emotional support and practical tips for living with the condition. Organizations like the National Ankylosing Spondylitis Society (NASS) offer valuable resources and information for individuals with AS.

How important is regular monitoring in AS management?

Regular monitoring is crucial in AS management for several reasons:

• Assessing treatment effectiveness
• Detecting potential complications early
• Adjusting treatment plans as needed
• Monitoring for medication side effects
• Tracking disease progression

Individuals with AS should maintain regular check-ups with their rheumatologist and other healthcare providers involved in their care. These appointments may include physical examinations, imaging studies, and blood tests to comprehensively evaluate the patient’s condition and treatment response.

In conclusion, while there is no cure for ankylosing spondylitis, a combination of exercise, physiotherapy, medications, and lifestyle modifications can effectively manage symptoms and improve quality of life for many individuals with AS. As research continues, new treatments and management strategies may emerge, offering hope for even better outcomes in the future. It’s essential for individuals with AS to work closely with their healthcare team to develop and adjust their treatment plan, ensuring the best possible management of their condition.

Ankylosing spondylitis – Treatment – NHS

There’s no cure for ankylosing spondylitis (AS), but treatment is available to help relieve the symptoms.

Treatment can also help delay or prevent the process of the spine joining up (fusing) and stiffening.

These treatments can also help if you have non-radiographic axial spondyloarthritis.

In most cases treatment involves a combination of:

• exercise
• physiotherapy
• medicine

Physiotherapy and exercise

Keeping active can improve your posture and range of spinal movement, along with preventing your spine becoming stiff and painful.

As well as keeping active, physiotherapy is a key part of treating AS. A physiotherapist can advise about the most effective exercises and draw up an exercise programme that suits you.

Types of physiotherapy recommended for AS include:

• a group exercise programme – where you exercise with others
• an individual exercise programme – you are given exercises to do by yourself
• hydrotherapy – exercise in water, usually a warm, shallow swimming pool or a special hydrotherapy bath; the buoyancy of the water helps make movement easier by supporting you, and the warmth can relax your muscles

Some people prefer to swim or play sport to keep flexible. This is usually fine, although some daily stretching and exercise is also important.

If you’re ever in doubt, speak to your physiotherapist or rheumatologist before taking up a new form of sport or exercise.

The National Ankylosing Spondylitis Society (NASS) has detailed information about different types of exercise to help you manage your condition.

Painkillers

You may need painkillers to manage your condition while you’re being referred to a rheumatologist. The rheumatologist may continue prescribing painkillers, although not everyone needs them all the time.

Non-steroidal anti-inflammatory drugs (NSAIDs)

The first type of painkiller usually prescribed is a non-steroidal anti-inflammatory drug (NSAID). As well as helping ease pain, NSAIDs can help relieve swelling (inflammation) in your joints.

Examples of NSAIDs include:

• ibuprofen
• naproxen
• diclofenac
• etoricoxib

When prescribing NSAIDs, your GP or rheumatologist will try to find the 1 that suits you and the lowest possible dose that relieves your symptoms. Your dose will be monitored and reviewed as necessary.

Paracetamol

If NSAIDs are unsuitable for you or if you need extra pain relief, an alternative painkiller, such as paracetamol, may be recommended.

Paracetamol rarely causes side effects and can be used in women who are pregnant or breastfeeding. However, paracetamol may not be suitable for people with liver problems or those dependent on alcohol.

Codeine

If necessary, you may also be prescribed a stronger type of painkiller called codeine.

Codeine can cause side effects, including: 

• feeling sick
• being sick
• constipation
• drowsiness

Biological treatments

Anti-TNF medicine

If your symptoms cannot be controlled using NSAIDs and exercising and stretching, anti-tumour necrosis factor (TNF) medicine may be recommended. TNF is a chemical produced by cells when tissue is inflamed.

Anti-TNF medicines are given by injection and work by preventing the effects of TNF, as well as reducing the inflammation in your joints caused by ankylosing spondylitis.

If your rheumatologist recommends using anti-TNF medicine, the decision about whether they’re right for you must be discussed carefully, and your progress will be closely monitored.

In rare cases anti-TNF medicine can interfere with the immune system, increasing your risk of developing potentially serious infections.

If your symptoms do not improve significantly after taking anti-TNF medicine for at least 3 months the treatment will be stopped. You may be offered a different anti-TNF medicine.

Monoclonal antibody treatment

Monoclonal antibodies, such as secukinumab and ixekizumab, may be offered to people with AS who do not respond to NSAIDs or anti-TNF medicine, or as an alternative to anti-TNF medicine.

This type of treatment works by blocking the effects of a protein involved in triggering inflammation.

JAK inhibitors

JAK inhibitors such as upadacitinib are a new type of medicine that may be offered to people with AS who do not respond to anti-TNF medicine or cannot take it.

They work by blocking enzymes (proteins) that the immune system uses to trigger inflammation. They’re taken as tablets.

Corticosteroids

Corticosteroids have a powerful anti-inflammatory effect and can be taken as injections by people with AS.

If a particular joint is inflamed, corticosteroids can be injected directly into the joint. You’ll need to rest the joint for up to 48 hours after the injection.

It’s usually recommended to limit corticosteroid injections to no more than 3 times in one year, with at least 3 months between injections in the same joint.

This is because corticosteroid injections can cause a number of side effects, such as:

• infection in response to the injection
• the skin around the injection may change colour (depigmentation)
• the surrounding tissue may waste away
• a tendon near the joint may burst (rupture)

Disease-modifying anti-rheumatic drugs (DMARDs)

Disease-modifying anti-rheumatic drugs (DMARDs) are an alternative type of medicine often used to treat other types of arthritis.

DMARDs may be prescribed for AS, although they’re only beneficial in treating pain and inflammation in joints in areas of the body other than the spine.

Sulfasalazine and methotrexate are the main DMARDs sometimes used to treat inflammation of joints other than the spine.

Surgery

Most people with AS will not need surgery. However, joint replacement surgery may be recommended to improve pain and movement in the affected joint if the joint has become severely damaged.

For example, if the hip joints are affected, a hip replacement may be carried out.

In rare cases corrective surgery may be needed if the spine becomes badly bent.

Follow-up

As the symptoms of AS develop slowly and tend to come and go, you’ll need to see your rheumatologist for regular check-ups.

They’ll make sure your treatment is working properly and may carry out physical assessments to assess how your condition is progressing. This may involve further sets of the same blood tests or X-rays you had at the time of your diagnosis.

Page last reviewed: 05 January 2023
Next review due: 05 January 2026

Ankylosing spondylitis – Diagnosis & treatment

Diagnosis

During the physical exam, your health care provider might ask you to bend in different directions to test the range of motion in your spine. Your provider might try to reproduce your pain by pressing on specific portions of your pelvis or by moving your legs into a particular position. You also may be asked to take a deep breath to see if you have difficulty expanding your chest.

Imaging tests

X-rays allow doctors to check for changes in joints and bones, also called radiographic axial spondyloarthritis, though the visible signs of ankylosing spondylitis, also called axial spondyloarthritis, might not be evident early in the disease.

Magnetic resonance imaging (MRI) uses radio waves and a strong magnetic field to provide more-detailed images of bones and soft tissues. MRI scans can reveal evidence of nonradiographic axial spondyloarthritis earlier in the disease process, but they are much more expensive.

Lab tests

There are no specific lab tests to identify ankylosing spondylitis. Certain blood tests can check for markers of inflammation, but many different health problems can cause inflammation.

Blood can be tested for the HLA-B27 gene. But many people who have the gene don’t have ankylosing spondylitis, and people can have the disease without having the HLA-B27 gene.

More Information

Treatment

The goal of treatment is to relieve pain and stiffness and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others) — are the medicines health care providers most commonly use to treat axial spondyloarthritis and nonradiographic axial spondyloarthritis. These medicines can relieve inflammation, pain and stiffness, but they also might cause gastrointestinal bleeding.

If nonsteroidal anti-inflammatory drugs (NSAIDs) aren’t helpful, your doctor might suggest starting a tumor necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor. These medicines are injected under the skin or through an intravenous line. Another option is a Janus kinase (JAK) inhibitor. janus kinase (JAK) inhibitors are taken by mouth. These types of medicines can reactivate untreated tuberculosis and make you more prone to infections.

Examples of tumor necrosis factor (TNF) blockers include:

• Adalimumab (Humira).
• Certolizumab pegol (Cimzia).
• Etanercept (Enbrel).
• Golimumab (Simponi).
• Infliximab (Remicade).

interleukin-17 (IL-17) inhibitors used to treat ankylosing spondylitis include secukinumab (Cosentyx) and ixekizumab (Taltz). JAK inhibitors available to treat ankylosing spondylitis include tofacitinib (Xeljanz) and upadacitinib (Rinvoq).

Therapy

Physical therapy is an important part of treatment and can provide a number of benefits, from pain relief to improved strength and flexibility. A physical therapist can design specific exercises for your needs. To help preserve good posture, you may be taught:

• Range-of-motion and stretching exercises.
• Strengthening exercises for abdominal and back muscles.
• Proper sleeping and walking positions.

Surgery

Most people with ankylosing spondylitis or nonradiographic axial spondyloarthritis don’t need surgery. Surgery may be recommended if you have severe pain or if a hip joint is so damaged that it needs to be replaced.

More Information

Self care

Lifestyle choices also can help manage ankylosing spondylitis.

• Stay active. Exercise can help ease pain, maintain flexibility and improve your posture.
• Don’t smoke. If you smoke, quit. Smoking is generally bad for your health, but it creates additional problems for people with ankylosing spondylitis, including further hampering breathing.
• Practice good posture. Practicing standing straight in front of a mirror can help you avoid some of the problems associated with ankylosing spondylitis.

More Information

Coping and support

The course of your condition can change over time, and you might have painful episodes and periods of less pain throughout your life. But most people are able to live productive lives despite a diagnosis of ankylosing spondylitis.

You might want to join an online or in-person support group of people with this condition, to share experiences and support.

Preparing for your appointment

You might first bring your symptoms to the attention of your family health care provider. Your provider may refer you to a specialist in inflammatory disorders called a rheumatologist.

Here’s some information to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms, including any that may seem unrelated to the reason you made the appointment, and when they began.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines, vitamins and other supplements you take and their doses.
• Questions to ask your doctor.

Take a family member or friend along, if possible, to help you remember the information you’re given.

For ankylosing spondylitis, basic questions to ask your health care team include:

• What’s likely causing my symptoms?
• Other than the most likely cause, what are other possible causes for my symptoms?
• What tests do I need?
• Is my condition likely temporary or lifelong?
• What’s the best course of action?
• What are the alternatives to the primary approach you’re suggesting?
• I have other health conditions. How can I best manage them together?
• Are there restrictions I need to follow?
• Should I see a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• Where is your pain?
• How severe is your pain?
• Have your symptoms been continuous or occasional?
• What, if anything, seems to worsen or improve your symptoms?
• Have you taken medicines to relieve the pain? What helped most?

Spondylitis – a disease of the spine | Blog ММЦ Clinic №1 Lublino, Moscow

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Spondylitis is a disease of the spine that is easy to miss at an early stage

01/29/2021

Spondylitis is a disease of the spine in which inflammation develops and primary destruction of the vertebral bodies occurs. The disease deforms the spine: gradually the vertebrae grow together with each other or with other parts of the skeleton – the ribs, the sacrum and even the pelvic bones.

In vertebral spondylitis, the ligaments of the spine become ossified, causing severe pain and significantly reducing mobility. The longer the diagnosis and treatment of spondylitis is delayed, the higher the risk of being immobilized and in a wheelchair.

Causes

Spondylitis occurs due to damage to the immune system by infectious diseases and has an autoimmune pathology. The immune system fails and attacks its own cells, thereby destroying bone tissue. The body replenishes bone mass through scarring. The scars of adjacent bones grow together over time, forming one fixed connection.

Spondylitis can be either specific or non-specific. Specific is caused by a specific disease. Nonspecific is a complication of the disease or occurs after surgery and other invasive procedures.

The main causative agent of specific spondylitis is Staphylococcus aureus, but the disease can occur due to tuberculosis bacillus (tuberculous spondylitis develops), causative agents of syphilis, gonorrhea and brucellosis, as well as enterobacteria and other pathogens.

Nonspecific hematogenous purulent spondylitis, as a rule, occurs in the thoracic and lumbar spine, rarely in the cervical. It can become a complication of furunculosis, tonsillitis, dental caries and appear after operations on the abdominal cavity, kidneys and pelvic organs.

The genetic predisposition should not be discounted either: if someone in the family has had or is suffering from spondylitis, the risk of discovering the disease in the next generation is quite high.

Symptoms and stages of spondylitis

Spondylitis appears at 20-30 years of age and is more common in men.

In the primary stage, mild back pain in the lumbar region is observed. Symptoms are not so significant that the patient immediately sought medical help.

Over time, lower back pain gets worse, more frequent and lasts longer. Rest and sleep do not bring relief. In the morning there is a feeling of stiffness, which gradually disappears from slight physical mobility.

In the secondary stage of the disease, spondylitis moves from the lumbar spine to the thoracic and cervical. Characteristic signs: very severe pain in the back (not only in the lower back), which is difficult to drown out with painkillers. Movements are constrained and limited due to constant muscle tension.

The development of vertebral spondylitis leads to muscle atrophy, and fusion with the ribs limits the mobility of the chest and leads to breathing problems. In addition, autoimmune diseases affect any healthy cells, including cells of internal organs. Therefore, spondylitis can cause damage to the heart, kidneys, lungs, eyes and other organs.

Diagnosis

Spondylitis of any type and at any stage is diagnosed by x-ray, computed tomography, magnetic resonance imaging, scintigraphy and laboratory tests (blood test, urinalysis and other tests if necessary).

The procedures necessary for diagnosis are determined by the attending physician on the basis of the anamnesis: initial examination, patient complaints and the results of previous examinations, if any.

Treatment

Treatment depends on the type of spondylitis, the causative agent and the stage of the disease. At the primary stage, the main task of the doctor is to eliminate the source. If it is a bacterial infection, a course of antibiotics is prescribed. If spondylitis is a complication of another disease, the doctor’s task is to cure this disease and at the same time slow down the development of spondylitis. If vertebral spondylitis, specific or nonspecific, is started, an operation or several operations are required, plus drug therapy and long-term rehabilitation.

Any type and stage of spondylitis may require spinal stabilization, physical therapy, and medication. Specific methods of treatment and medications are selected by the attending physician.

Spondylitis cannot be completely cured, but its development can be slowed down as much as possible. Therefore, a timely visit to a doctor can prevent the appearance of a wheelchair in a patient’s life.

After a course of treatment, on the recommendation of a doctor, it is necessary to periodically do CT, MRI or X-rays and take tests (C-reactive protein and ESR).

Photo: ru.freepik.com

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Spinal spondylitis – symptoms, causes, treatment

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Spinal spondylitis is a general term for degenerative-dystrophic changes of a chronic nature. It is characterized by primary destruction of the bone tissue of the vertebral bodies, deformation and limitation of mobility of the spinal column, pain syndrome. Conditionally divided into two types: specific – obtained as a result of infection with an acute infection, and ankylosing or non-specific, related to manifestations of rheumatism.

CMRT specialist tells

Kuchenkov A.V.

Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor • 25 years of experience

Publication date: May 19, 2021

Verification date: January 11, 2023

All facts have been verified by a doctor.

Contents of the article

Causes of spondylitis

Symptoms

Symptoms of spondylitis increase as the disease progresses, divided into primary and secondary signs.

Primary:

• limitation of mobility in certain postures
• occurrence of periodic pain in the cervical, thoracic or sacral region, which increases as the disease worsens
• malaise, fever, redness of the area of ​​the disease localization

Secondary include the development of reactivity. For example, reactive spondylitis of the lumbar spine gives symptoms of kyphosis. Either a violation of the natural curves, when the spinal column takes an unnaturally even position, or a shortening of the length of the spine, the appearance of a hump.

The rapid development of purulent spondylitis gives rapidly emerging symptoms from acute pain, fever to intoxication – nausea, vomiting, headache, general weakness.

Classification

Pathology is classified depending on the pathogenesis of the disease into specific and non-specific spondylitis.

According to the localization of manifestations, the following are distinguished: spondylitis of the cervical, thoracic and lumbar spine.

By the nature of the course – slowly progressive, with exacerbations, impetuous.

How to diagnose

To differentiate the pathology, use:

Laboratory blood tests – complete blood count, culture for sterility or PCR test to determine the pathogen;

MRI – informative for joint lesions, inflammation of soft tissues, shows aseptic spondylitis of the lumbar spine at an early stage

Computed tomography

If necessary – biopsy of the body of the affected vertebra or disc.

Rehabilitation of the spine: material of the specialists of the RC “Laboratory of Movement”

Go to

Which doctor to contact

How to treat spondylitis of the spine

Rehabilitation after spinal spondylitis

Consequences

Prevention

Treatment and rehabilitation after spinal spondylitis in CMRT clinics

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