An Expert's Perspective on Treating Ankylosing Spondylitis

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The early symptoms of ankylosing spondylitis (AS), also known as spinal arthritis, are usually minor back pain and stiffness. But AS manifests in different ways for different people. Some people will have occasional flare-ups (or worsening of pain symptoms) in their lower backs. Others may experience pain and inflammation in large joints throughout their bodies such as hips and knees, or in organs such as the eyes and bowels. With all the different symptoms associated with ankylosing spondylitis, the condition can be difficult to diagnose and also difficult to treat. Nick Shamie, MD, chief of orthopedic surgery at the David Geffen School of Medicine at UCLA, discusses the most common questions he gets about treating ankylosing spondylitis.

1. Q: What is ankylosing spondylitis?

A: Ankylosing spondylitis is a form of arthritis that affects the joints of the spine (vertebrae) and usually the sacroiliac joint (where the spine meets the pelvis). Ankylosing means to join (or fuse) together. Spondylitis means inflammation of the spine. Often, but not always, the inflammation in the spine will cause the vertebrae to form bony growths that join together. Mobility and flexibility may be impacted depending on where the bone fusion occurs. Unlike other types of arthritis, AS mostly affects people under the age of 40. Because ankylosing spondylitis can lead to inflammation in other parts of the body, there are a number of conditions associated with it, including uveitis (inflammation of the eye) and inflammatory bowel disease.

2. Q: How is ankylosing spondylitis diagnosed?

A: Ankylosing spondylitis can be difficult to diagnose because the initial symptoms are pain and stiffness in the lower back, and those are very common issues. But, if a patient continually returns with these symptoms, I will conduct a physical exam and ask for a family health history. The condition tends to run in families, so having a close relative with AS would put you at a higher risk than the general population. A blood test is also used to detect a protein marker called HLA-B27, which is present in a majority of Caucasians with this disease. However, the detection of this marker does not guarantee an ankylosing spondylitis diagnosis. An X-ray or magnetic resonance imaging (MRI) will determine if areas of the spine or sacroiliac joints are fused together or if increased inflammation is present. All this information together goes into diagnosing AS.

3. Q: What are ankylosing spondylitis treatment options?

A: The first line of treatment for AS is physical therapy combined with pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs); you may try over-the-counter NSAIDs such as ibuprofen (Advil) and naproxen (Aleve) or prescription-strength celecoxib (Celebrex) or indocin (Indomethacin). These drugs reduce pain and inflammation and can prevent or delay the spine from fusing. However, if NSAIDs are not controlling the pain or inflammation adequately, other treatments include:

  • Disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine (Azulfidine) or methotrexate (Rheumatrex); these drugs are used to treat related pain in the knees, hips, shoulders, and sacroiliac joints.

  • Corticosteroids, such as dexamethasone (Ozurdex); these drugs are used for severe pain and inflammation, and are injected directly into problematic joints for a fast-acting but short-term treatment.

  • Biologics (TNF and IL-17 Inhibitors), such as adalimumab (Humira), etanercept (Enbrel) and secukinumab (Cosentyx); these are strong immune-suppressing drugs that block proteins in the body that cause inflammation.

  • Surgery; this step is taken only for severe, advanced cases of ankylosing spondylitis where the deformity is debilitating, usually in the neck.

4. Q: How do you determine which treatment is right for the patient?

A: It’s the same as with any other medical condition: the severity of the condition dictates the treatment. In early cases of ankylosing spondylitis, physical therapy and regular follow-up with your physician is usually recommended. In cases where there is significant pain, or you want to prevent fusion in the vertebrae, your doctor may prescribe NSAIDs. If those are not working, or there are contraindications, we move on to the next line of approved medications.

5. Q: What lifestyle changes can patients make to improve their ankylosing spondylitis?

A: First of all, don’t ignore your body. If you have pain, or you notice something unusual, seek an expert opinion and follow your physician’s instructions. Secondly, it’s important to eat a well-balanced diet and maintain a healthy weight. Excess pounds can impact your ability to exercise, and exercising is one of the most effective ways to manage AS-related pain. We have a saying in our practice: “life is motion; motion is life.” Our goal is to have the patients get as mobile as they can as quickly as they can. Also, stress could have a negative impact by triggering flare-ups, so getting enough sleep is an important way to manage your stress levels and overall well-being.

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THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.