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Medical Content Created by the Faculty of the
Harvard Medical School

Ankylosing Spondylitis

Treatment

The aim of treatment is to reduce joint pain and to prevent, delay or correct any damage or deformities of the spine and other joints.

Medications
A number of medications may be effective, including anti-inflammatory drugs (such as ibuprofen), pain relievers (such as acetaminophen), sulfasalazine or methotrexate. The injectable medications adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), and Simponi (golimumab) were recently approved for ankylosing spondylitis. Early studies suggest that these drugs may be much more effective than older drugs.

Daily Management
Treatment usually includes physical therapy and exercise. A physical therapist will develop an exercise routine for you that probably will include range-of-motion and stretching exercises to help the spine remain flexible. Abdominal and back exercises can help you maintain good posture so you are less likely to stoop. Swimming is an especially good exercise because it may be easier to move stiff, painful areas in the water. Biking also tends to be a good exercise for people with ankylosing spondylitis. Avoid any activities that could put too much stress on your back. For example, jogging may cause back pain to become worse because jogging puts more pressure on spinal joints.

Hot baths, heat and massage can help to relieve pain. If you can, sleep on your back on a firm mattress and use a small pillow or none at all.

Because ankylosing spondylitis can affect the bones of the rib cage, your lung capacity can become restricted. Breathing exercises can help maintain your lung capacity. If you smoke, quitting should be a priority. Even with the best treatment, some people will develop a fused spine, but most people can still function. At some point, a back brace or other devices, such a corset, cane or joint splints, may help. If other organs are involved, such as your heart or eye, you may have to see a specialist, and may need additional treatment and monitoring. For example, a person with ankylosing spondylitis may need a pacemaker if his or her heart is affected.

Surgery
Surgery is needed only if the disease has caused nerve damage in the spine or if joint damage is severe.