Key takeaways

  • A variety of medications, including NSAIDs and TNF inhibitors, can help relieve pain and reduce inflammation associated with ankylosing spondylitis.
  • Physical therapy and regular exercise can improve flexibility and posture, helping to manage symptoms and prevent further joint damage.
  • While there’s no cure, a combination of medication, self-care, and exercise can help manage the symptoms of ankylosing spondylitis and improve quality of life.

Ankylosing spondylitis (AS) is part of the spectrum of spondyloarthropathies (SpA). Instead of using the term “ankylosing spondylitis,” healthcare professionals now refer to this condition as part of the spondyloarthritis spectrum.

Living with AS means you’ll experience at least some pain and stiffness, especially in your lower back, hips, and buttocks.

But you don’t have to settle for days filled with pain, because treatment is available.

While these treatments won’t cure your disease, they can prevent further joint damage and improve your comfort level and flexibility.

There are a variety of medications available to treat AS. Common options include nonsteroidal anti-inflammatory drugs (NSAIDs), tumor necrosis factor (TNF) inhibitors, and steroids.

NSAIDs

NSAIDs such as aspirin, ibuprofen (Advil, Motrin), indomethacin (Tivorbex), and naproxen (Naprosyn) are often the first choice for treating AS.

These drugs do double duty: They relieve pain and reduce inflammation in your spine and other parts of your body. Taking NSAIDs can enable you to stay active and do the exercises that will help keep your joints flexible.

But use NSAIDs with caution. Take them only when you need them. These drugs can cause side effects such as ulcers and stomach bleeding, and long-term use can affect your kidney function.

TNF inhibitors

If NSAIDs don’t relieve your pain, your doctor might recommend biologic drugs called TNF inhibitors. Five TNF inhibitors have been approved by the Food and Drug Administration (FDA) to treat AS:

  • adalimumab (Humira)
  • certolizumab pegol (Cimzia)
  • etanercept (Enbrel)
  • golimumab (Simponi)
  • infliximab (Remicade)

These drugs target a substance in your blood called TNF, which promotes inflammation. You’ll receive these medications as an injection under your skin or as an intravenous (IV) infusion.

TNF inhibitors can cause side effects. Common side effects include burning and itching at the injection site. Possible serious side effects include an increased risk of developing lymphoma and skin cancers.

These drugs also increase your risk of infections, including tuberculosis (TB) and fungal infections. Before you start treatment, your doctor will test you for TB and for hepatitis B and C.

It’s important to update your immunizations before starting treatment with TNF inhibitors. Biosimilar forms of these drugs are also available, and they may be cheaper. Talk with your doctor for more information about your specific needs.

Additional medications

Other drugs approved to treat this condition include IL-17 inhibitors and Janus kinase (JAK) inhibitors.

Treatment for arthritis in your other joints differs from the treatment for AS. For peripheral joints, like those in your hands, feet, and knees, your doctor may prescribe additional treatments, including disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine and methotrexate.

Steroids

If one area of your body, such as your hips or knees, is very painful, your doctor might give you a shot of steroids directly into the affected joint. Steroid injections relieve pain and bring down inflammation.

Uveitis (eye inflammation) is a common complication of AS. Without proper treatment, it can cause partial or complete vision loss. Consult an eye doctor if your eye is red, painful, or sensitive to light.

A doctor can prescribe steroid eye drops to treat uveitis. Taking a TNF inhibitor will help prevent uveitis from coming back in the future.

A physical therapist can teach you exercises to strengthen your muscles and improve your flexibility. You’ll also learn how to improve your posture to avoid putting too much pressure on your spine and worsening your symptoms.

Some people find that doing these exercises in a pool makes them feel better. But any type of physical therapy can be helpful for managing AS.

It’s also important for you to exercise regularly at home. Ask your doctor or physical therapist to recommend exercises that are right for you, and make sure to learn how to perform the exercises correctly. It might be helpful for you to follow along with an exercise video designed for people with arthritis.

Do your workout at the time of day when you feel most comfortable. If your joints are especially tight in the morning, exercising in the afternoon or evening may be a better option.

Take 5 to 10 minutes to warm up before you exercise. Walk in place or stretch to loosen up your muscles. Start slowly and never work out to the point of discomfort.

Applying a heating pad or an ice pack can feel soothing on sore joints. Heat therapy can help relieve joint stiffness, while cold therapy can reduce swelling and soothe acute pain.

Use whichever one feels better to you, and apply it for only short periods of 10 to 15 minutes. Also, be careful not to put anything extremely hot or cold directly on your skin, as doing so could cause a burn.

Eating a particular diet won’t cure AS, but it could help you feel better.

Certain foods are beneficial because of their anti-inflammatory properties. These include flaxseed, fatty fish such as salmon and tuna, and nuts such as walnuts.

If your doctor recommends it, losing some weight may help take some pressure off your painful joints. Limiting your portion sizes and reducing your calorie intake may help. Talk with your doctor about the best ways to manage your weight.

Doctors typically do not recommend surgery for AS. But if you also have severe joint damage from arthritis, you may need a hip or knee replacement to relieve pain and restore your range of motion.

Here are some frequently asked questions about the treatment of ankylosing spondylitis.

What is the best treatment for ankylosing spondylitis?

Various treatment options are available to manage ankylosing spondylitis, including medications such as NSAIDs, TNF inhibitors, and steroids, as well as physical therapy and surgery.

The best treatment will depend on your specific needs. Your doctor can work with you to create a care plan suitable for your circumstances.

Can I live a normal life with ankylosing spondylitis?

It is usually possible to live a typical life with appropriate AS treatment and management, but you may have additional needs in the long term as the condition progresses. You might have greater difficulty with some activities, such as walking and exercising, and may eventually lose the ability to do those activities.

What is the life span of a person with ankylosing spondylitis?

Ankylosing spondylitis does not typically affect life span, so the life span of someone with the condition may be comparable to that of someone who does not have it.

However, having ankylosing spondylitis can increase your risk of certain conditions that can be potentially life threatening, such as cardiovascular disease, spinal fractures, and osteoporosis.

If you have AS, you don’t have to live in pain. While there is currently no cure for the condition, there are medications, self-care options, and exercises available to help you manage the symptoms. You can talk with your doctor about the best treatment options for you.