Treatment & Prognosis
Although there is no cure for ankylosing spondylitis, most sufferers can manage inflammatory symptoms with a combination of regular exercise, and drug therapy
- Daily physiotherapy, including swimming, in order to maintain good posture and chest expansion, and prevent physical deformity over time
- Daily stretching and spinal exercises to prevent stiffness and physical restrictions
- NSAIDs (non-steroidal anti-inflammatory drugs), which reduce inflammation – indomethacin is the most widely prescribed NSAID for ankylosing spondylitis, but other types are just as helpful, based on each patient’s individual experience with the efficacy and side effects of the medication.
- DMARDs (disease-modifying anti-rheumatic drugs), such as sulfasalazine or methotextrate, can be very helpful as a complementary treatment for patients suffering from pain and arthritic-type symptoms in peripheral joints in AS, such as the shoulders, hips and ankles.
- Biologics have made a huge difference in the lives of patients with AS. Remicade, Humira, Enbrel, and Simponi have all had success in reducing pain, stiffness and improving quality of life. It is not clear if they prevent bone and tissue fibrosis, or fusion.
- Bisphosphonates (a class of drugs that prevent the loss of bone mass) can be used to stem the effects of osteoporosis that may accompany AS-related inflammation.
- Corticosteroids, although assessed as providing no pain relief in the axial spine, can help reduce any related synovitis (inflammation) in the peripheral joints.
- Simple, non-narcotic analgesics, such as aspirin (acetylsalicylic acid, or ASA) and Tylenol (Acetaminophen) can also be helpful in reducing pain but should not be used as primary therapy.
The prognosis for AS sufferers is good; the majority of patients experience mild to moderate expressions of the disease, maintain some mobility and independence throughout their life, and have a normal lifespan.
Due to pain, fatigue and mobility issues, many sufferers of ankylosing spondylitis must modify their type and hours of work, and occasionally negotiate some form of accommodation from their employers in order to sustain any physical aspect of their work.
Long-standing sufferers of ankylosing spondylitis may have a reduced life expectancy (and, rarely but not unexpectedly, premature death), due to complications from associated diseases, such as amyloidosis, aortic valve diseases, trauma from fractures, and risks associated with drugs, surgical treatments, radiotherapy, ulcerative colitis and Crohn’s disease.
Pregnancy can present complications for women with ankylosing spondylitis, as there is no tendency for AS to go into remission, and fusion of the sacroiliac joints can produce severe pain and potential for problematic delivery.
Surgery can also be a problem, as patients with cervical spine involvement can have difficulty with intubation. Patient’s need to have anesthesia consulted prior to any surgical procedure and their cervical spine fully assessed.