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  • About Arthritis
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    woman holding her wristWhat Is Arthritis?

    Arthritis is not one disease. Learn about the different types of arthritis, how they differ and why it’s important.

    microbesInflammation and the Immune System

    Body-wide inflammation is at the root of most chronic diseases — and you may have more control over it than you think.

    Patient talking with nurseNewly Diagnosed With Arthritis

    A new arthritis diagnosis can be overwhelming. These tips can help.

    • Understanding Arthritis
    • Arthritis Types
    • More About Arthritis
    • Where it Hurts
    • Related Conditions
  • Treatments
    Common Topics
    Woman holding shoulderWebinar: Touch Therapies for Pain Management

    Learn the evidence behind popular touch therapies for arthritis, including what to try and what to avoid, for how long and when.

    Managing Arthritis Care Costs

    Learn the basics about health care costs and financial tools available to you.

    Man with head in hands on bedWebinar: Arthritis Fatigue Causes and Solutions

    Learn the various causes of arthritis-related fatigue and strategies to combat weariness.

    • Treatment Plan
    • Drug Guide
    • Joint Surgery
    • Complementary Therapies
    • Insurance Management
  • Healthy Living
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    Woman with upset stomachMicrobiome, Gut Health & Arthritis

    Microbiome, microbes, microorganisms – these terms may be confusing, but the types of bacteria living in and on our bodies can impact arthritis. Learn what helps or harms the microbiome and the health of your gut and discover dietary changes that can make a difference. This episode was originally released on January 19, 2021.

    man exercisingStairs Workout Demo

    Strengthen your leg muscles and improve your stability to make going up and down stairs safer and easier.

    woman consoling anotherArthritis and Mental Health

    Learn about the connection between arthritis, depression and anxiety and how these conditions can make your arthritis worse.

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    2023 JA Family Summit

    Learn about the National Juvenile Arthritis Conference, a place for families to connect, share and learn.

    JA Camps

    The Arthritis Foundation’s JA camp programs give kids with arthritis and related childhood rheumatic diseases the chance to make lasting memories.

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    • About Juvenile Arthritis
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    Transforming Clinical Interactions

    The Live Yes! Arthritis community connects patients with others online and in-person for support and education, and encourages patients to play an active role in their health care.

    Partners 4 Patients with Arthritis

    The Arthritis Foundation recently launched an initiative to build stronger relationships and increase recognition of our most engaged practices. 

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    See how we're aiming to address the growing shortage of arthritis specialists, especially in under-served parts of the country.

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    OACS Forum Series

    The Osteoarthritis Clinical Studies Forum Series features OA thought leaders from across the globe discussing the future of how the disease can be treated to improve patient outcomes.

    man bandaging boy's kneeConquering Childhood Arthritis

    The Arthritis Foundation is mobilizing patients and their families to engage in studies comparing the effectiveness of treatments for juvenile arthritis and funding research for more options.

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    Capital hillAction Center

    Take action today - use the resources here to learn who your elected officials are, what opportunities we have to advocate from the comfort of your own home, federal and state legislation, and more!

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    Share your experience in a 10-minute assessment to be among those changing the future of arthritis.

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    You may have arthritis, but it doesn't have you. The Arthritis Foundation’s one-of-a-kind podcast. Hosted by patients, for patients.

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Treatment Options for Axial Spondyloarthritis

Whether you have ankylosing spondylitis or nonradiographic axial spondyloarthritis, treatment can slow the disease and make you more comfortable.

Updated April 12, 2022

Treatment for axial spondyloarthritis (axSpa) — including nonradiographic axSpA (nr-axSpA) and ankylosing spondylitis (AS) — aims to:

  • Reduce pain and stiffness.
  • Prevent deformities.
  • Help you continue normal activities. 

Disease control involves medication, physical therapy, exercise and living a lifestyle to support your well-being. Treatments include medications, exercise and other lifestyle measures, and sometimes surgery. Work closely with your doctor to devise the best treatment plan for you.

Medications

Medications are an essential part of treatment for most people with axSpA. They may include some of the following:

  • NSAIDs. Nonsteroidal anti-inflammatory drugs are usually the first treatment for axSpA. You may be prescribed high doses to control inflammation.
  • Sulfasalazine. Conventional synthetic disease-modifying antirheumatic drugs (DMARDs) are not usually used in people with just spinal disease. Sulfasalazine, however, may be used when joints other than those in the back and pelvis are affected and you don't get enough relief from NSAIDs.
  • Biologics. These medications will be used if your disease is very active or doesn’t respond well to NSAIDs. The category of biologic that works best for axSpA is called a tumor necrosis factor (TNF) inhibitor. If your disease doesn’t respond to an anti-TNF drug, your doctor may try a biologic that blocks interleukin-17 (IL-17). Several biologics and their biosimilars are currently approved for use in AS: adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), ixekizumab (Taltz) and secukinumab (Cosentyx). Three (Cimzia, Taltz and Cosentyx) are approved by the FDA to treat nr-axSpA.
  • Analgesics. The pain reliever acetaminophen can ease pain if you aren’t able to take NSAIDs. It won’t reduce inflammation.
  • Glucocorticoids (corticosteroids). Injecting this powerful anti-inflammatory directly into your knees or shoulders can provide quick and effective relief. They are not often injected into the spine, and they are not taken by mouth for axSpA.

Every medication comes with risks and possible side effects. Talk to your doctor about your medication risks.

Physical Therapy and Exercise

Regular physical activity is an important piece of your overall treatment plan. The goal is to preserve range of motion in your neck and back. Working with an experienced physical therapist is strongly recommended, especially if you have spinal involvement. The PT can help create a strength and mobility program for you and show you how to move in ways that are beneficial and won't cause further damage.
Exercises that strengthen the back and neck and keep them flexible will help maintain or improve your posture. Deep-breathing exercises and aerobic activities will aid in keeping your chest and rib cage flexible. Swimming is a good option because it keeps your spine, neck, shoulders and hips strong and supple, but if you don't have access to a pool, you should focus on strength-building, flexibility and cardiovascular activities.
Try taking a warm bath or shower to loosen your joints and muscles before you work out. Begin slowly and plan to do your routine when you are the least tired and have the least pain. If you have heart or lung disease, check with your doctor to see if it’s safe to exercise.

Living With AxSpA

Along with physical therapy and medications, you can do many things on your own to take charge of your health and feel better overall.

Be Proactive

  • Take a hands-on approach to your treatment.
  • Become a good self-manager.
  • Build your health care team.
  • Keep track of symptoms, medications, side effects and pain levels.
  • Get regular check-ups and keep up with your immunizations.
  • Ask questions and share concerns with your health care team.

Maintain Good Posture

  • Whether you’re sleeping, sitting or standing, maintain a proper body position to prevent joints from fusing in unwanted positions.
  • Invest in a firm mattress and try to sleep on your back with a thin pillow or no pillow. Keep your legs straight instead of sleeping in a curled position.
  • Keep your back as straight as you can when walking or sitting, with your shoulders squared and your head up.
  • Skip corsets and braces. They aren’t usually helpful and may be hurtful in treating AS.

Stop Smoking
If you smoke, stop. Smoking will worsen any lung problems you have from axSpA and may prevent your medications from working fully. If your rib cage is stiff, any smoking-related breathing issues may feel worse.

Use Self-Help Devices
If you have limited mobility, self-help devices can make your daily tasks easier. An occupational therapist can advise you about aids and assistive devices.

Seek Emotional Wellness

Feeling sad, worried or anxious are all common reactions to having a chronic disease. The body-wide inflammation may even contribute to depression. But you can learn to cope with arthritis, improve your mood and ease worries.

Communicate with Your Partner

Limited movement — especially of the hip joint — may get in the way of sexual activity. Some extra planning and communication can help. Discussing your needs with your partner will help you overcome almost any difficulty.

Think about what you do to make yourself comfortable when lying in bed. Then adapt these changes of position to make sexual activities more comfortable and fun for both partners.

Make Workplace Accommodations

The majority of people with axSpA can continue a productive, active work schedule. Whether you work inside or outside the home, the following suggestions may help.

  • Avoid lifting, stooping and remaining in cramped or bent positions.
  • Raise your computer monitor to eye level so your posture is good.
  • Change positions often and move around at least every hour.
  • Use a cushion when sitting to help support your back.
  • Arrange to take short rest periods throughout the day.

Eat Well

There is no specific diet for AS. However, a food plan rich in vegetables, fruit, fish and healthy fats like olive oil will help support an overall healthful lifestyle.

Ease Pain and Fatigue

Along with exercise and medications, try these methods to relieve pain, fatigue and anxiety.

  • Activity pacing. Lighten your schedule and ask for help when you need to. Take breaks during the day to save energy and protect joints.
  • Hot and cold treatments. Heat improves blood flow, easing joint stiffness. Cold helps reduce swelling by constricting blood vessels.
  • Relaxation techniques. Relax your muscles and slow down your thoughts. Try deep breathing, guided imagery and visualization.
  • Massage. Massage can help reduce pain, improve joint function and ease stress and anxiety.
  • Topical treatments. Pain creams can be rubbed on the skin over a painful joint. They may contain NSAIDs, salicylates, counter-irritants or capsaicin.
  • Acupuncture. Acupuncture is the practice of inserting fine needles at special points into the body to relieve pain.  

Surgery

Despite everyone’s best efforts, sometimes joint surgery is necessary to improve your function. Hip and knee replacements are quite successful for people with axSpA. If your spine becomes severely bent forward, surgery may help straighten it. Because the surgery is complex, it’s done in only a few medical centers.

Ankylosing Spondylitis Related Articles
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The First Medications for Axial Spondyloarthritis

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The First Medications for Axial Spondyloarthritis
Understand your treatment options when you are first diagnosed with axial spondyloarthritis (axSpA), including ankylosing spondylitis (AS)
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First Steps Toward Axial Spondyloarthritis Treatment

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First Steps Toward Axial Spondyloarthritis Treatment
Learning you have a chronic disease can be confusing. Focus on these four things to start managing axial spondyloarthritis, including ankylosing spondylitis.
Read More
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The Arthritis Foundation is focused on finding a cure and championing the fight against arthritis with life-changing information, advocacy, science and community. We can only achieve these goals with your help. Strong, outspoken and engaged volunteers will help us conquer arthritis. By getting involved, you become a leader in our organization and help make a difference in the lives of millions. Join us and become a Champion of Yes.

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Live Yes! INSIGHTS


Give Just 10 Minutes.

Tell us what matters most to you. Change the future of arthritis.

By taking part in the Live Yes! INSIGHTS assessment, you’ll be among those changing lives today and changing the future of arthritis, for yourself and for 54 million others. And all it takes is just 10 minutes.

Your shared experiences will help:

- Lead to more effective treatments and outcomes
- Develop programs to meet the needs of you and your community
- Shape a powerful agenda that fights for you

Now is the time to make your voice count, for yourself and the entire arthritis community. 

Currently this program is for the adult arthritis community.  Since the needs of the juvenile arthritis (JA) community are unique, we are currently working with experts to develop a customized experience for JA families. 

How are you changing the future?

By sharing your experience, you’re showing decision-makers the realities of living with arthritis, paving the way for change. You’re helping break down barriers to care, inform research and create resources that make a difference in people’s lives, including your own.

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Meet Our Partners

As a partner, you will help the Arthritis Foundation provide life-changing resources, science, advocacy and community connections for people with arthritis, the nations leading cause of disability. Join us today and help lead the way as a Champion of Yes.

Trailblazer

Our Trailblazers are committed partners ready to lead the way, take action and fight for everyday victories. They contribute $2,000,000 to $2,749,000

Visionary

Our Visionary partners help us plan for a future that includes a cure for arthritis. These inspired and inventive champions have contributed $1,500,00 to $1,999,999.

Pioneer

Our Pioneers are always ready to explore and find new weapons in the fight against arthritis. They contribute $1,000,000 to $1,499,999.

Pacesetter

Our Pacesetters ensure that we can chart the course for a cure for those who live with arthritis. They contribute $500,000 to $999,000.

Signature

Our Signature partners make their mark by helping us identify new and meaningful resources for people with arthritis. They contribute $250,000 to $499,999.

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Our Supporting partners are active champions who provide encouragement and assistance to the arthritis community. They contribute $100,000 to $249,999.

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