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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Spondylitis of the lumbar spine – symptoms and treatment, how to treat degenerative spondylitis of the vertebrae

Articles

Reading time 10 min cov. When the joints and ligaments of the spine are involved in the pathological process, the disease is called spondyloartitis. The first signs of spondylitis of the lumbar spine are bouts of dull pain in the lower back and stiffness in the back, mainly in the morning. Without treatment, the disease ends in disability.

Spondylitis occurs in 5% of all spinal diseases. Most often diagnosed in patients aged 40-50 years, but sometimes affects adolescents and young adults. Men suffer the disease more severely, although they get sick with the same frequency as women.

In the article we will tell you how lumbar spondylitis manifests itself, when and which doctor you need to contact. Specialists of the Temed Clinic in Moscow and other cities examine patients with back pain. If the doctor detects spondylitis or other inflammatory processes in the spine, then he refers the patient to a specialized specialist for treatment. Make an appointment with a neurologist if you are suffering from pain in the lower back or other part of the back. The doctor will find out why the pain occurred and determine the tactics of examination and treatment.

This article is advisory in nature. Treatment is prescribed by a specialist after consultation. How does spondylitis develop? It begins to attack the tissues of its own spinal column – bones, cartilage, ligaments

Fig. 1 Fused vertebrae in spondylitis – bamboo spine

Types of spondylitis

According to localization, spondylitis is divided into cervical, thoracic, lumbar and sacral. Spondyloarthritis often affects the lumbosacral region and the joints that connect the sacrum to the pelvic bones.

According to the causes, spondylitis is divided into non-infectious and infectious, the latter is non-specific and specific. Specific spondylitis is caused by bacteria and parasites: mycobacteria, brucella, treponema. Nonspecific include purulent spondylitis, in which bacteria enter the vertebral bodies from the source of infection through the blood vessels, as well as ankylosing spondylitis, or Bechterew’s disease with an autoimmune mechanism of development.

Noninfectious spondylitis is caused by trauma, degenerative changes in the spine, and other factors.

Fig. 2 Types of spondylitis depending on the cause

Depending on which edge of the vertebra is affected by inflammation, spondylitis occurs: 2 2

posterior – posterior margin affected vertebra

Diagnosis can indicate not only the affected spine, but also the localization of inflammation in the vertebra itself. For example, anterior lumbar spondylitis means that the inflammatory process has affected the anterior sections of the lumbar vertebrae.

Causes of spondylitis

Spondylitis often develops against the background of long-term infectious processes in the body caused by Staphylococcus aureus, Mycobacterium tuberculosis, Escherichia or Pseudomonas aeruginosa. Spondylitis can be caused by infections of the genitourinary and digestive systems, abscesses in the spine, an infectious lesion of the heart – endocarditis.

In addition to infections, other pathological processes or conditions can lead to the development of spondylitis:

• Immunodeficiency

• Back injuries

• Genetic mutations. In ankylosing spondylitis, a mutation of the HLA-B27 gene occurs, which can also cause ulcerative colitis, Crohn’s disease, and inflammation of the choroid

• Degenerative-dystrophic changes in the spine. This type of inflammation of the vertebrae is sometimes called degenerative spondylitis

• Endocrine diseases

• Congenital anomalies of the spine gunshot wounds or injuries

Regardless of the cause of spondylitis, it has characteristic signs and requires serious and long-term treatment.

Symptoms of lumbar spondylitis

The disease usually develops gradually. One of the first symptoms is lower back pain, often on one side. The back can hurt with certain movements. Over time, the pain intensifies, becomes bilateral and spreads to neighboring parts of the spine, buttocks and legs. There is stiffness in the lower back in the morning.

Pain in spondylitis has characteristic features:

• is moderate, dull

• sometimes appears at night and wakes the patient, but more often in the morning

• 900 02 increases after periods of immobility and decreases after physical activity

In addition to pain, other symptoms may appear with spondylitis:

• noticeable limitation of movement in the lower back0104

• fever

• fatigue

Sometimes the pain in the back is mild or appears after the loss of mobility. Consult a doctor for any discomfort in the back, so as not to miss the onset of the disease and start treatment on time.

Which doctor to contact

If you have back pain, you can contact a general practitioner, neurologist or orthopedic traumatologist. After examination and initial diagnosis, the doctor will decide whether a consultation with another specialist is needed: a neurosurgeon, endocrinologist, venereologist, infectious disease specialist, phthisiatrician.

Make an appointment with a neurologist

Appointment lasts 60 minutes, includes diagnostics, analysis of your MRI and preparation of a treatment plan, takes place both in person and online.

Diagnosis of lumbar spondylitis

Examination helps to exclude similar diseases and find the cause of spondylitis: symptoms and treatment directly depend on what caused the disease.

At the Temed Clinic, patients with back pain are consulted by a neurologist. In the process of communicating with the patient, he clarifies:

• when and what symptoms appeared
• whether the patient has comorbidities, autoimmune diseases or genetic predisposition to specific diseases
• how severe and prolonged the pain is
• actions relieve pain

Diagnostic criteria exist which indicate the development of spondylitis:

• pain often appears at night and in the morning
• rest does not bring relief
• pain decreases with movement
• illness begins gradually
• for a patient about 40–50 years old sacrum, iliac bones and joints between the pelvis and spine, to identify painful areas. Draws attention to external changes. Assesses the posture and curvature of the spine, as well as the degree of its mobility. Performs a neurological examination and tests muscle strength, sensation, and tendon reflexes in the limbs.

  To confirm the diagnosis, the doctor may order any of these instrumental studies: a special substance and evaluate how the bone tissue accumulates it

• general clinical and biochemical blood tests

How is lumbar spondylitis treated

The doctors of our clinic do not treat infectious spondylitis and other inflammatory diseases of the spine, but if it is suspected, they will refer the patient to competent and experienced specialists for therapy.

Therapeutic tactics for non-infectious spondylitis is aimed at stopping the development of the disease, eliminating the focus of inflammation, relieving pain, and improving spinal mobility. To do this, apply:

• Drug therapy

  The choice of drugs depends on the cause that caused the disease. In case of infection, a course of antibiotics is prescribed. Painkillers are used to relieve pain and inflammation. Muscle spasms associated with pain are sometimes treated with muscle relaxants, and with severe inflammation, corticosteroids

• Physiotherapy

  Only for non-infectious spondylitis. It helps to improve blood circulation in the affected area, reduce inflammation and swelling, anesthetize and stop the destruction of the vertebrae. Apply shock wave therapy, magnetotherapy and laser therapy

• exercise therapy

  Specially designed exercises help strengthen the muscles and ligaments of the spine and increase range of motion. Therapeutic exercise is prescribed after inflammation and severe pain pass

• Massage

  Prescribed during the rehabilitation period as an additional therapy for muscle relaxation

brain.

Complications and prognosis in chronic spinal spondylitis

Prognosis in spondylitis depends on many factors:

• type and severity of the disease
• age of the patient
• comorbidities
• timeliness and correctness of treatment

Most patients have a favorable prognosis. But if the disease is not treated, complications can occur:

• chronic debilitating back pain
• sleep problems due to pain cove

With purulent spondylitis, fistulas can form – passages that connect the purulent focus with the external environment or the cavity of the spinal canal.

Lumbar ankylosing spondylitis can lead to cauda equina syndrome. With this syndrome, a bundle of spinal nerve roots is compressed – the function of the pelvic organs suffers, the sensitivity and muscle strength of the limbs decrease.

Tuberculous spondylitis can be complicated by spinal deformity, irreversible damage to the spinal cord, fistulas.

Prevention of spondylitis and its complications

To prevent inflammatory diseases of the spine, you must follow these rules:

To summarize:

• 1

  Lumbar spondylitis is a chronic inflammatory disease spine, which is manifested by pain and impaired mobility in the lumbar region. Occurs more often at 40-50 years old, but also occurs in younger people Spondylitis is treated with medication, as well as with the help of physiotherapy and exercise therapy. Surgical treatment is offered to the patient when conservative therapy does not work. Without treatment, spondylitis leads to spinal immobility and other irreversible complications.

• 3

  If you have back pain or other spinal problems, make an appointment with a neurologist at your nearest Temed Clinic. The doctor will determine the cause of poor health and draw up an examination plan.

List of sources:

1. https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc -20354808
2. Lawrence H Brent, MD , Anand Patel, MD, Herbert S Diamond, MD. Ankylosing spondylitis and undifferentiated spondyloarthropathy. Medscape. Jun 14, 2022
3. MEDICINAL BULLETIN No. 4 (76). 2019. Volume 13, Ankylosing spondylitis in the practice of a clinician
4. Bochkova A.G., Levshakova A.V. Why is the diagnosis of ankylosing spondylitis late? Neurology, neuropsychiatry, psychosomatics.