Ankylosing Spondylitis.
Last updated Friday, February 11, 2005
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Management and treatment
Treatment
Treatment for ankylosing spondylitis should be designed to reduce
pain and stiffness, prevent deformities, and help you maintain your
normal activities.
The basics of treatment include:
- Education
- Attention to posture
- Exercise
- Medications
Should these approaches fail to provide adequate relief and should the spine, hips, knees or shoulders become damaged or painful, there are a number of reconstructive surgical procedures available, including spine surgery, total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty.
Health care team
You should choose a doctor experienced in treating arthritis. Your
doctor will work with you to decide when you need the help of other
health professionals, such as physical or occupational therapists.
Effective treatment of ankylosing spondylitis relies on a partnership between you and your care providers.
Exercise and therapy
Regular exercise is an essential part of the overall management of
ankylosing spondylitis. Your physical therapist with arthritis
experience can design a program of exercises
to meet your needs. Exercises that strengthen the back and neck will
help maintain or improve your posture. Deep breathing exercises and
aerobic exercises will help keep the chest and rib cage flexible.
Swimming is an excellent way to exercise since it promotes flexibility
of the spine; movement of the neck, shoulder, and hip joints; and deep
breathing.
If you sometimes feel too stiff and sore to exercise, try
taking a hot bath or shower to loosen up. Begin your exercises slowly
and plan to do them when you are the least tired or have the least
pain.
Whether your overall medical
condition would permit an exercise regime would be a good topic for you
to discuss with your internist, family doctor, or rheumatologist. The
initiation of a fitness program in someone who has never participated
in one before certainly should be done under the guidance of a
physician or physical therapist.
Physical therapy is not believed to prevent progression of AS, but it may minimize symptoms in some patients.
Posture
Make every effort to keep your spine straight. Sleep on a hard
mattress. Try to sleep on your stomach without a pillow under your
head. You also can try sleeping on your back with a thin pillow or one
that supports the hollow of your neck. Keep your legs straight rather
than sleeping in a curled position. If you find it difficult to sleep
in these positions, talk to a physical therapist about other possible
options.
When walking or sitting, keep your spine as straight as you
can with your shoulders squared and your head up. A test for correct
posture can be done by standing with your back against the wall; your
heels buttocks, shoulders, and head should be able to touch the wall
all at once. Be sure that chairs and work surfaces are designed so that
you don't slump or stoop.
Corsets and braces, in general, are of little value in
treating ankylosing spondylitis. You are much better off maintaining
good posture by exercising properly.
Medications
Medication is
usually an essential and ongoing part of treatment. While medications
do not cure ankylosing spondylitis, they do relieve pain and stiffness,
allowing you to exercise, maintain good posture, and continue normal
activities.
Several types of medication help treat ankylosing spondylitis. Nonsteroidal anti-inflammatory drugs (NSAIDs)
reduce inflammation and relieve pain. Typical NSAIDs include
indomethacin, piroxicam, or naproxyn. Side effects of NSAIDs include
stomach upset leg swelling and rarely ulcers or bleeding from the
stomach. Newer NSAIDs, known as the COX-2 inhibitors (rofecoxib,
celecoxib) may be able to relieve inflammation and painwith fewer side
effects. Aspirin has been found to be of little use in treating
ankylosing spondylitis. Higher doses of NSAIDs are usually required to
relieve the inflammation in addition to the pain.
A medication called sulfasalazine has been shown to reduce the
inflammation and symptoms of ankylosing spondylitis, but it is not
known whether sulfasalazine may slow or halt the progression of the
disease. Some of the new medications that affect an inflammatory
substance called TNF are being investigated as possible agents that may
affect the course of theillness.
Whichever medications your doctor prescribes for you, be sure to take
them as directed, even when you seem to be feeling fine. Also, talk to
your doctor about possible side effects and what to do if they occur.
If your symptoms worsen, call your doctor.
Surgery
Surgery
is a rare measure used in the management of ankylosing spondylitis.
Joint replacement surgery is enabling many people to regain the use of
joints that have been affected by ankylosing spondylitis and other
forms of arthritis. Hip, knee, and shoulder replacements can be
successful in ankylosing spondylitis. Rarely surgery can be done to
straighten the spine but requires a significant expertise and should
only be done by those with experience in the this area.
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