By Dr Ananya Mandal, MD
Ankylosing spondylitis has no cure. Most of the treatments aim to relieve symptoms and delay the progress of the disease and prevent the spinal deformities and disability.
Physiotherapy and keeping active helps in maintaining the flexibility of the spine and delays the progress of the disease. Stiffness and pain in the spine are also prevented with regular sessions of physiotherapy.
Physiotherapy is the cornerstone in treating ankylosing spondylitis. A physiotherapist advises the most effective exercises that are suitable for the patient and helps draw a plan for treatment of the condition with exercises.
Exercises prescribed may be performed in a group exercise programme or an individual exercise programme. Massage is also advised in some cases. Here the muscles and other soft tissues are manipulated to relieve pain and improve movement. This needs to be done by experts to prevent injury to the bones and muscles.
Another form of therapy suggested is hydrotherapy. Here the exercises are usually performed under water. The water is warm and shallow and may be a special hydrotherapy bath. Here the weight of the water helps improve blood flow, relaxes the muscles and relieves pain.
Electrotherapy is also tried by some sufferers. Small electric currents or impulses are passed though the muscles to ease pain and promote healing.
Other exercises like swimming and yoga may also be performed. All sports and exercises need to be cleared by the attending physiotherapist or rheumatologist before they are attempted to prevent injury and damage to the spine.
Pain relievers or NSAIDs (Non steroidal anti-inflammatory drugs)
The NSAIDs help in two ways – they relieve the pain and ease the inflammation. The commonest agents prescribed include Ibuprofen, diclofenac, naproxen etc. These however are fraught with side effects like gastric ulcers, kidney damage etc. Long term continued use is thus unadvisable.
In some individuals pain relief may be inadequate with NSAIDs and paracetamol. They may require opioid analgesics or Codeine. Codeine and other opioids however may cause side effects such as constipation, nausea, drowsiness and may lead to dependence and abuse.
Biologicals like tumour necrosis factor (TNF) blockers
These agents target the actual pathology of the condition rather than its symptoms. TNF is a chemical produced by cells when tissue is inflamed. TNF blockers or inhibitors help curb this TNF mediated inflammation.
Examples of TNF blockers include adalimumab, etanercept, golimumab etc. These agents are relatively new in ankylosing spondylitis though they have been used extensively in rheumatoid arthritis.
These may be used only if the diagnosis of ankylosing spondylitis is confirmed and level of pain is assessed twice 12 weeks apart to note no improvement with other therapies.
After 12 weeks of treatment with TNF blockers the pain scores and other scores are tested to check for improvements.
Calcium replenishing and bone forming agents like bisphosphonates
These agents are valuable in treatment of osteoporosis. Osteoporosis may develop as a complication of ankylosing spondylitis. Bisphosphonates may also be effective in treating ankylosing spondylitis.
Bisphosphonates including Alendronate, resedronate, zoledronate etc. can be taken by mouth as tablets or given by injection.
Disease-modifying anti-rheumatic drugs or DMARDs
These agents are useful in rheumatoid arthritis. DMARDs may be prescribed for ankylosing spondylitis but benefit those with involvement of peripheral joints such as knees, hips, shoulders, ankles and wrists. The ones that may be used include methotrexate and sulfasalazine.
Corticosteroids are anti-inflammatory agents that can be taken as injections (in acute cases) or as tablets. In case of inflamed joints the drug may also be given directly into the joint by injection. This is called intra-articular injections.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)