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Treatments and drugs
By Mayo Clinic staffThe goal of treatment is to relieve your pain and stiffness, and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage to your joints.
Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen (Aleve, Naprosyn) and indomethacin (Indocin) — are the medications doctors most commonly use to treat ankylosing spondylitis. They can relieve your inflammation, pain and stiffness. However, these medications also can cause gastrointestinal bleeding.
If NSAIDs aren't helpful, your doctor may suggest tumor necrosis factor (TNF) blockers. TNF is a cell protein that acts as an inflammatory agent in rheumatoid arthritis. TNF blockers target this protein to help reduce pain, stiffness, and tender or swollen joints. They are administered by injecting the medication under the skin or through an intravenous line.
Examples of TNF blockers include:
- Adalimumab (Humira)
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Golimumab (Simponi)
TNF blockers can reactivate latent tuberculosis and may cause certain neurological problems.
Therapy
Physical therapy can provide a number of benefits, from pain relief to improved physical strength and flexibility. Your doctor may recommend that you meet with a physical therapist to provide you with specific exercises designed for your needs.
Range-of-motion and stretching exercises can help maintain flexibility in your joints and preserve good posture. In addition, specific breathing exercises can help to sustain and enhance your lung capacity.
As your condition worsens, your upper body may begin to stoop forward. Proper sleep and walking positions and abdominal and back exercises can help maintain your upright posture. Even if portions of your spine eventually fuse, you'll be able to get around and perform daily functions more easily if your spine fuses in an upright position.
Surgery
Most people with ankylosing spondylitis don't need surgery. However, your doctor may recommend surgery if you have severe pain or joint damage, or if a hip joint is so damaged that it needs to be replaced.
- Braveman SE. Ankylosing spondylitis. In: Frontera WR, et al. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4160-4007-1..50112-7&isbn=978-1-4160-4007-1&type=bookPage§ionEid=4-u1.0-B978-1-4160-4007-1..50112-7--cesec5&uniqId=228570791-3. Accessed Nov. 30, 2010.
- Yu DT. Clinical manifestations of ankylosing spondylitis in adults. http://www.uptodate.com/home/index.html. Accessed Nov. 30, 2010.
- Mercier LT. Ankylosing spondylitis. In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05610-6..00010-X--sc0225&isbn=978-0-323-05610-6&sid=1090462943&type=bookPage§ionEid=4-u1.0-B978-0-323-05610-6..00010-X--sc0225&uniqId=228720493-4#4-u1.0-B978-0-323-05610-6..00010-X--sc0225. Accessed Nov. 30, 2010.
- Yu DT. Treatment and prognosis of ankylosing spondylitis in adults. http://www.uptodate.com/home/index.html. Accessed Nov. 30, 2010.
- Inman RD. Clinical subsets of the spondyloarthropathies: Ankylosing spondylitis. In: Goldman L, et al. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4160-2805-5..50291-3--cesec29&isbn=978-1-4160-2805-5&sid=1090462943&type=bookPage§ionEid=4-u1.0-B978-1-4160-2805-5..50291-3--cesec33&uniqId=228720493-4#4-u1.0-B978-1-4160-2805-5..50291-3--cesec33. Accessed Nov. 30, 2010.
- Van der Linden SM, et al. Ankylosing spondylitis. In: Firestein GS, et al. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2009. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4160-3285-4..10070-1&isbn=978-1-4160-3285-4&sid=1090462943&type=bookPage§ionEid=4-u1.0-B978-1-4160-3285-4..10070-1&uniqId=228720493-4#4-u1.0-B978-1-4160-3285-4..10070-1. Accessed Nov. 30, 2010.
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