Ankylosing Spondylitis Treatment
There is no specific treatment plan for ankylosing spondylitis. The goals of treatment are to reduce pain and stiffness, to prevent deformity, and to maintain function (i.e., range of motion). Patients with AS should maintain a healthy body weight, eat a balanced diet, and should not smoke. Patients also should maintain proper posture and avoid slouching.
Regular exercise is the most important aspect of AS treatment. Swimming is a good form of exercise for many patients, because it usually does not increase joint pain. In some cases, physical therapy and hot/cold therapy are also beneficial.
Medications to Treat Ankylosing Spondylitis
Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line medications used to treat AS. These drugs can help reduce symptoms (e.g., pain, stiffness) so that patients are able to follow through with the prescribed exercise program.
NSAIDs that may be used include the following:
- Diclofenac and misoprostol (Voltaren, Arthrotec)
- Ibuprofen (Advil, Motrin)
- Indomethacin (e.g., Indocin)
- Meloxicam (e.g., Mobic)
Side effects of these medications include abdominal pain, nausea, diarrhea, and bleeding in the gastrointestinal tract. These drugs should always be taken with food or milk to reduce the risk for these side effects. Antacids and other medications (e.g., sucralfate [Carafate], which "coats" the stomach) also may be used to help reduce side effects.
In severe cases, NSAIDs may not be enough to control AS symptoms. Other medications that may be prescribed include sulfasalazine (e.g., Azulfidine), methotrexate (e.g., Rheumatrex), corticosteroids (prednisone), and newer medications called TFN-a (tumor necrosis factor alpha) blockers.
Sulfasalazine is an oral medication that may be used to reduce pain and swelling. Side effects include nausea, headache, and rash. Patients who are taking this drug require regular blood tests to monitor for bone marrow suppression, which is a rare side effect.
Methotrexate is a chemotherapy drug that may be used in small doses to treat ankylosing spondylitis. Patients who are taking methotrexate also must take folic acid to reduce the risk for side effects, such as nausea and oral (mouth) ulcers. Patients who are taking this medication require regular blood tests and liver function tests to detect bone marrow suppression and liver problems.
Tumor necrosis factor alpha (TNF-a) is a substance that plays a role in the inflammatory process of ankylosing spondylitis. Medications that block production of this substance (TNF-a blockers) can effectively slow progression of the disease, in some cases. TNF-a blockers include Etanercept (Enbrel) and infliximab (Remicade).
Etanercept is administered as an injection, usually once per week. Infliximab is administered through an IV (called intravenous infusion). In AS patients, it usually is administered 2 weeks, then 6 weeks after the initial dose, and then once every 6 weeks thereafter.
These medications increase the risk for serious side effects, including an increased risk for infections (e.g., tuberculosis [TB]). Before receiving these drugs, patients usually are required to undergo a TB test. In rare cases, TNF-a blockers increase the risk for cancers, such as leukemia and lymphoma.
Oral corticosteroids (e.g., prednisone) may be used in patients with severe symptoms who do not respond to other treatments. These medications are not used for long-term treatment of AS because they may cause severe side effects, including lower resistance to infections.
Patients with severe AS that does not respond to treatment may require hip replacement surgery (total hip arthroplasty), total shoulder replacement (rarely), or spinal surgery.
Complications of ankylosing spondylitis that involve the eyes (e.g., iritis, uveitis) usually are treated using cortisone eye drops. In severe cases, oral or injectable corticosteroids may be used.