Table of ContentsView AllTable of ContentsLifestyle ChangesPhysical TherapyOver-the-Counter (OTC) TherapiesPrescriptionsSurgeryComplementary/Alternative MedicineFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Lifestyle Changes
Physical Therapy
Over-the-Counter (OTC) Therapies
Prescriptions
Surgery
Complementary/Alternative Medicine
Frequently Asked Questions
While there is no cure forankylosing spondylitis(AS), a treatment regimen that consists ofphysical therapyand medication can effectively ease a person’ssymptomsof joint pain, stiffness, and swelling, and also improve everyday functioning.
The American College of Rheumatology (ACR) created guidelines for treating ankylosing spondylitis that were meant to help healthcare providers optimize the care of their patients with AS in a systematic way, based on research studies.
As aperson with AS(or as someone with a friend or family member who has AS), knowledge about treatment guidelines will help you navigate this complex and chronic disease more confidently.
Quitting smoking is an essential component for improving symptoms from ankylosing spondylitis. Evidence suggests thatsmoking may exacerbate disease symptoms.
Exercise is also an important part of treatment for ankylosing spondylitis. Daily exercise can helpdecrease symptomsand increase your mobility, flexibility, and strength.Practicing good posture may also help prevent long-term complications. Your healthcare provider can help you develop an exercise plan that is safe and effective for you.
10 Exercises for AS
In addition to medication, theAmerican College of Rheumatologyrecommends physical therapy for people with active AS (meaning those who have symptoms of inflammation like joint pain and stiffness).
A number ofstudieshave found physical therapy to be beneficial in reducing pain and improving spinal mobility, posture, flexibility, physical functioning, and well-being.
The good news is there is little harm associated with physical therapy. Also, a person can engage in exercises and stretches at home or within a group setting. However, research does suggest that supervised group physical therapy may be more beneficial than home exercises.
What may be even more appealing (and luxurious) for those with AS is a type of therapy called spa-exercise therapy. This type of therapy includes exercising in warm water, undergoing a massage from hydrotherapy jets, and relaxing in a steamy sauna.
In fact,researchhas found that spa-exercise therapy combined with group physical therapy is better than group physical therapy alone.
How to Make Living With Ankylosing Spondylitis Easier at Home
Non-Steroidal Anti-Inflammatory (NSAID) Therapy
For instance, one well-known potential harm of NSAID therapy is that it may cause stomach damage, ulcers, and bleeding. NSAIDs can also increase your risk of heart attack, heart failure, or stroke. They may also raise a person’s blood pressure and cause or worsen kidney problems.
In addition to these potential harms, NSAIDs may interact with your other medications. This is why it is important to tell and ask your healthcare provider about all of the medications you are taking, including herbals, vitamins, or supplements.
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There are a number of different NSAIDs available to treat AS, including both over-the-counter NSAIDs and prescription NSAIDs. Examples include:
Tumor Necrosis Factor Inhibitors (TNFi)
The good news about TNF blockers is there is ample scientific evidence to support their benefit in reducing disease activity in ankylosing spondylitis—in other words, quieting the inflammation down in the body.
TNF blockers are not completely benign therapies. They do have risks, and this must be weighed carefully for each person.
Due to the fact that TNF blockers suppress a person’s immune system (albeit an overactive one in the cases of those with ankylosing spondylitis), they can increase a person’s risk of both mild infection and serious infection. An example of a mild infection is a common cold. On the other hand, a serious infection that healthcare providers especially worry about when a person is taking a TNF inhibitor is tuberculosis.
Due to the risk of tuberculosis reactivation, a TB test is required before initiating TNF blocker therapy. Rarely, TNF blockers have been linked to an increased chance of developing certain cancers.
It’s also important to know that certain people are not candidates for taking TNF blockers. Conditions that would prevent a person from being able to take TNF blockers would be considered contraindications.
Contraindications for TNF BlockersMultiple sclerosisHeart failureAn active infection like pneumonia
Contraindications for TNF Blockers
Multiple sclerosisHeart failureAn active infection like pneumonia
People who are pregnant or breastfeeding may not be candidates for TNF blocker therapy.
According to current medical guidelines, a person should only be considered for a TNF blocker if their disease does not improve with at least two different types of NSAIDs (at a maximum dose tolerated).
The TNF blockers used to treat ankylosing spondylitis are:
Remicade, Inflectra, and Renflexis (infliximab) are given as an infusion through the vein, while Enbrel (etanercept), Humira (adalimumab), Simponi (golimumab), and Cimzia (certolizumab) are given as subcutaneous (into the fat tissue) injections.
Interleukin-17 (IL-17) Blockers
Cosentyx is given subcutaneously once a week for four weeks, and then every four weeks thereafter.Researchsuggests that it’s well-tolerated, with the most common adverse effect being cold symptoms, like a runny nose and sore throat. Research is still evolving on Cosentyx.
Janus Kinase (JAK) Inhibitors
Janus kinase(JAK) inhibitors work against enzymes that promote inflammation. Xeljanz (tofacitinib)and Rinvoq (upadacitinib)are both FDA-approved for adult patients with active ankylosing spondylitis who have had an inadequate response or intolerance to one or more TNF blockers.
In rare instances, surgery is needed to treat ankylosing spondylitis. This is usually reserved for people with severe hip joint damage and pain. In these instances, a total hip replacement is often recommended over no surgery at all.
Riskier surgeries like those involving the spine are much less common and performed when there is severe downward curving of the spine (“hunchback posture”).
Some people choose to pursue alternative methods in addressing their AS as well. These methods have not been through the rigorous studies necessary for drug approval. However, some people with AS have reported benefits from the following:
It is important to note that the effectiveness of these therapies has not been established. Chiropractic treatment, in particular, is a concern of mainstream healthcare providers, who worry that it might lead to complications such as spinal fractures.
Frequently Asked QuestionsArheumatologist, a type of practitioner who specializes in joint and musculoskeletal conditions, treats AS. Your primary care doctor may refer you to one, but if they do not, look for one who is experienced at treating patients with AS. You may also see other health care practitioners, such as aphysical therapistor ophthalmologist, to manage specific aspects of AS.Possibly. Although diet has not been extensively studied as a treatment for AS, an anti-inflammatory diet high in omega-3s has been shown to be beneficial for otherinflammatory conditions. Omega-3 supplements may also provide some benefits.Your healthcare provider may suggest anumber of medicationsto treat AS after evaluating your condition:NSAIDs are the most common first treatment option.DMARDsmay help control inflammation (though evidence is currently lacking that they reduce symptoms or slow the progression of AS).Corticosteroidscan help relieve acute pain and inflammation, but aren’t a good long-term option.Biologics, which can reduce pain and inflammation and slow disease progression, are the newest class of drugs used to treat AS.
Arheumatologist, a type of practitioner who specializes in joint and musculoskeletal conditions, treats AS. Your primary care doctor may refer you to one, but if they do not, look for one who is experienced at treating patients with AS. You may also see other health care practitioners, such as aphysical therapistor ophthalmologist, to manage specific aspects of AS.
Possibly. Although diet has not been extensively studied as a treatment for AS, an anti-inflammatory diet high in omega-3s has been shown to be beneficial for otherinflammatory conditions. Omega-3 supplements may also provide some benefits.
Your healthcare provider may suggest anumber of medicationsto treat AS after evaluating your condition:NSAIDs are the most common first treatment option.DMARDsmay help control inflammation (though evidence is currently lacking that they reduce symptoms or slow the progression of AS).Corticosteroidscan help relieve acute pain and inflammation, but aren’t a good long-term option.Biologics, which can reduce pain and inflammation and slow disease progression, are the newest class of drugs used to treat AS.
Your healthcare provider may suggest anumber of medicationsto treat AS after evaluating your condition:
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ward MM, Deodhar A, Akl EA, 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 Rheumatol. 2016;68(2):282-98. doi:10.1002/art.39298Kaut IK, Abourazzak FE, Jamila E, et al.Axial spondyloarthritis and cigarette smoking.Open Rheumatol J. 2017;11:53-61. doi:10.2174/1874312901711010053Dagfinrud H, Kvien TK, Hagen KB.Physiotherapy interventions for ankylosing spondylitis.Cochrane Database Syst Rev. 2008 Jan 23;(1):CD002822. doi:10.1002/14651858.CD002822.pub2Crofford LJ.Use of NSAIDs in treating patients with arthritis. Arthritis Res Ther. 2013;15 Suppl 3:S2. doi:10.1186/ar4174Callhoff J, Sieper J, Weiß A, et al.Efficacy of TNFα blockers in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a meta-analysis.Ann Rheum Dis. 2015;74(6):1241-8. doi:10.1136/annrheumdis-2014-205322van der Heijde D, Sieper J, Maksymowych WP, et al.2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis.Ann Rheum Dis. 2011;70(6):905-8. doi:10.1136/ard.2011.151563Blair Ha, Dhillon S.Secukinumab: A review in ankylosing spondylitis.Drugs. 2016 Jul;76(10):1023-30. doi:10.1007/s40265-016-0598-8DailyMed.Xeljanz.DailyMed.Rinvoq.Complementary Treatments. Spondylitis Association of America.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ward MM, Deodhar A, Akl EA, 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 Rheumatol. 2016;68(2):282-98. doi:10.1002/art.39298Kaut IK, Abourazzak FE, Jamila E, et al.Axial spondyloarthritis and cigarette smoking.Open Rheumatol J. 2017;11:53-61. doi:10.2174/1874312901711010053Dagfinrud H, Kvien TK, Hagen KB.Physiotherapy interventions for ankylosing spondylitis.Cochrane Database Syst Rev. 2008 Jan 23;(1):CD002822. doi:10.1002/14651858.CD002822.pub2Crofford LJ.Use of NSAIDs in treating patients with arthritis. Arthritis Res Ther. 2013;15 Suppl 3:S2. doi:10.1186/ar4174Callhoff J, Sieper J, Weiß A, et al.Efficacy of TNFα blockers in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a meta-analysis.Ann Rheum Dis. 2015;74(6):1241-8. doi:10.1136/annrheumdis-2014-205322van der Heijde D, Sieper J, Maksymowych WP, et al.2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis.Ann Rheum Dis. 2011;70(6):905-8. doi:10.1136/ard.2011.151563Blair Ha, Dhillon S.Secukinumab: A review in ankylosing spondylitis.Drugs. 2016 Jul;76(10):1023-30. doi:10.1007/s40265-016-0598-8DailyMed.Xeljanz.DailyMed.Rinvoq.Complementary Treatments. Spondylitis Association of America.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ward MM, Deodhar A, Akl EA, 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 Rheumatol. 2016;68(2):282-98. doi:10.1002/art.39298Kaut IK, Abourazzak FE, Jamila E, et al.Axial spondyloarthritis and cigarette smoking.Open Rheumatol J. 2017;11:53-61. doi:10.2174/1874312901711010053Dagfinrud H, Kvien TK, Hagen KB.Physiotherapy interventions for ankylosing spondylitis.Cochrane Database Syst Rev. 2008 Jan 23;(1):CD002822. doi:10.1002/14651858.CD002822.pub2Crofford LJ.Use of NSAIDs in treating patients with arthritis. Arthritis Res Ther. 2013;15 Suppl 3:S2. doi:10.1186/ar4174Callhoff J, Sieper J, Weiß A, et al.Efficacy of TNFα blockers in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a meta-analysis.Ann Rheum Dis. 2015;74(6):1241-8. doi:10.1136/annrheumdis-2014-205322van der Heijde D, Sieper J, Maksymowych WP, et al.2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis.Ann Rheum Dis. 2011;70(6):905-8. doi:10.1136/ard.2011.151563Blair Ha, Dhillon S.Secukinumab: A review in ankylosing spondylitis.Drugs. 2016 Jul;76(10):1023-30. doi:10.1007/s40265-016-0598-8DailyMed.Xeljanz.DailyMed.Rinvoq.Complementary Treatments. Spondylitis Association of America.
Ward MM, Deodhar A, Akl EA, 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 Rheumatol. 2016;68(2):282-98. doi:10.1002/art.39298
Kaut IK, Abourazzak FE, Jamila E, et al.Axial spondyloarthritis and cigarette smoking.Open Rheumatol J. 2017;11:53-61. doi:10.2174/1874312901711010053
Dagfinrud H, Kvien TK, Hagen KB.Physiotherapy interventions for ankylosing spondylitis.Cochrane Database Syst Rev. 2008 Jan 23;(1):CD002822. doi:10.1002/14651858.CD002822.pub2
Crofford LJ.Use of NSAIDs in treating patients with arthritis. Arthritis Res Ther. 2013;15 Suppl 3:S2. doi:10.1186/ar4174
Callhoff J, Sieper J, Weiß A, et al.Efficacy of TNFα blockers in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a meta-analysis.Ann Rheum Dis. 2015;74(6):1241-8. doi:10.1136/annrheumdis-2014-205322
van der Heijde D, Sieper J, Maksymowych WP, et al.2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis.Ann Rheum Dis. 2011;70(6):905-8. doi:10.1136/ard.2011.151563
Blair Ha, Dhillon S.Secukinumab: A review in ankylosing spondylitis.Drugs. 2016 Jul;76(10):1023-30. doi:10.1007/s40265-016-0598-8
DailyMed.Xeljanz.
DailyMed.Rinvoq.
Complementary Treatments. Spondylitis Association of America.
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