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Ankylosing Spondylitis: Your Treatment Options

What Is Ankylosing Spondylitis?

Ankylosing spondylitis (AS) is a type of arthritis that causes lower back pain and stiffness.

Back pain from AS is not the same as more common types of back pain caused by things such as muscle spasms or slipped discs. AS back pain is caused by inflammation. It’s chronic, which means it is not a onetime thing. You will have it for a long time, but there are treatments to help lessen pain and stiffness. To get started, your doctor will look for some of these signs of inflammatory back pain.

  • Ongoing back pain that is more likely to start when you are young (in your 20s and 30s).
  • Your back pain lasts for 3 months or more (making it chronic).
  • Your pain is worse after rest.
  • Your pain tends to get better when you exercise or move around.
  • Anti-inflammatory drugs (like acetaminophen or ibuprofen) ease your pain and stiffness.

Who Gets AS?

AS tends to start between your teens and 30s. Men are two to three times more likely to get the disease than women. You can inherit it from your family. One gene, called HLA-B27, is common in people with AS.

What Are the Symptoms of AS?

AS usually affects the joints in your spine. Your first signs of AS may be low back pain and stiffness. You may feel symptoms before doctors can see AS on an X-ray. That can take up to 5 years. AS often causes inflammation in the tendons that attach your spine’s bones to muscles.

  • You may feel pain or have swelling in other joints like your hands, ribs, hips, shoulders, or feet from arthritis.
  • It can also affect other organs like your eyes, heart, skin, or intestines.
  • You may also feel tired.

Over many years, AS can cause new bone to grow on your spine, fusing the vertebrae making it harder to move. This can cause severe stiffness. About half the people who have AS develop osteoporosis, or brittle bones.

Axial and Peripheral AS

There are different forms of the disease. Lower back pain means you have axial AS. Pain and swelling in joints other than your spine is called peripheral AS.


How Is AS Diagnosed?

In addition to asking you about your symptoms, your doctor will do tests. A physical exam can show signs of inflammation in your joints or limited back movement. Your doctor will ask you about your medical history and find out if your parents or other relatives had the condition. You may see a specialist called a rheumatologist (an arthritis doctor) to diagnose or treat your AS.

Tests used to diagnose AS include:

X-ray. Remember, early on when you have AS, there may be no signs of the disease on an X-ray. It usually shows up after several years.
Magnetic resonance imaging (MRI). An image of your sacroiliac joints (where your spine connects to your pelvis) may show swelling and inflammation.
CT scan. An image that uses X-rays
Blood tests for the HLA-B27 gene or signs of inflammation

What Are the Treatments?

There are many medications used as ankylosing spondylitis treatments. Newer ones may stop inflammation before it starts to damage your joints or organs like your eyes. Treatments include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, indomethacin, meloxicam (Mobic), or naproxen
  • Corticosteroid shots in your joints
  • Disease-modifying antirheumatic drugs (DMARDs) like methotrexate or sulfasalazine (Azulfidine)
  • Biologic DMARDs like adalimumab (Humira), etanercept (Enbrel), golimumab (Simponi), or infliximab (Remicade)

Surgery can help a curved spine or neck, as well as damaged knees and hips.

Are There Alternative Treatments for AS?

Ask your doctor about how these techniques can help ease pain and stiffness in addition to your other treatments:

  • Acupuncture
  • Massage
  • Yoga
  • Transcutaneous electrical nerve stimulation (TENS)


What Can I Do to Improve My Quality of Life?

You can do many things to feel better and live an active life.

Keep moving. Daily exercise helps you stay flexible. It can help you ease back pain and stiffness. A physical therapist can teach you how to exercise safely. Work out in a warm pool to make movement easier.

Practice posture. Sitting and standing up straight may also help with pain and stiffness.

Heat and cold. Using moist heat pads or taking hot showers can ease your stiff, sore back. Cold packs can lower swelling in inflamed joints.

Healthy lifestyle and food choices. Keep a healthy body weight or ask your doctor how you can lose weight if you need to. Extra pounds stress your back and other joints. Smoking makes AS worse.


What’s It Like Long-Term When You Have AS?

AS shouldn’t affect how long you live.You may have mild back pain that comes and goes. But if your disease is more severe, your spine may curve or stiffen over time and may become fused. The rib cage can also become fused, making it hard to take a deep breath.

Follow these steps to feel your best with AS:

Follow your treatment plan. Take your drugs as prescribed, don’t smoke, and exercise daily to help ease your inflammation and prevent spine fusion or organ damage.

Watch for signs of inflammation in other areas. Talk to your doctor if you have pain or redness in your eyes, pain in your stomach, or a patchy rash on your skin.

Seek support. It’s helpful to talk to others who have AS. The Spondylitis Association of America has support groups in many areas as well as online communities: www.spondylitis.org.