Ankylosing Spondylitis Treatment
Treatment for AS focuses on reducing pain and stiffness, preventing deformities and allowing for the continuation of normal activities. The options include:
The doctor may recommend over-the-counter analgesics (pain relievers) such as acetaminophen (Tylenol) or prescribe an opioid analgesic such as tramadol (Ultram).
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs are the recommended first-line treatment for AS. They help relieve the symptoms – pain and stiffness – that come with this condition. NSAIDs that may be used to treat AS include over-the-counter drugs, such as ibuprofen (Advil) and naproxen (Aleve), as well as the prescription drugs indomethacin, diclofenac or celecoxib.
Disease-modifying Antirheumatic Drugs (DMARDs)
DMARDs can alter the course of AS. Some patients who don’t respond well to NSAIDs may be given a traditional DMARD such as sulfasalazine to reduce pain and swelling of the small joints of the hands or feet. Biologics, short for biologic response modifiers, are a subset of DMARDs. Biologics are the preferred treatment for patients with high disease activity that doesn’t respond well to NSAIDs. They work to control disease at the cellular level. There are several different forms of biologics; the one that works best with AS is called a tumor necrosis factor (TNF) inhibitor or, sometimes, an anti-TNF agent. Tumor necrosis factor is a substance found in cells that causes inflammation. Six biologic agents are currently approved to treat AS: infliximab, etanercept, adalimumab, certolizumab, secukinumab and golimumab.
Corticosteroid injections into the joint or surrounding tendons can provide relief as well. However, these treatments work best for patients with arthritis away from the spine; they don’t reduce pain and stiffness in the spine.
Joint replacement surgery allows many people to regain the use of joints damaged by AS.