What Is The Best Treatment For Ankylosing Spondylitis?
What Is Ankylosing Spondylitis?
Ankylosing spondylitis (AS) is chronic inflammatory arthritis that mainly affects the spinal joints. Ankylosing means “crooked and stiffened” and spondylitis is the “inflammation of vertebrae”. Occasionally other joints such as the hip and shoulder joints are involved. The main symptoms are back pain and stiffness. The back pain is sudden in onset, improves with exercise and worsens at night. It is characteristically present in adults from 20 to 30 years old. In addition, other organs like eyes (uveitis), bowel, lungs, heart and kidney can be affected. A rheumatologist usually diagnoses AS based on the medical history, family history, a thorough physical examination, X-ray and blood investigations including HLA-B27. Currently, there is no cure for AS but there are medications and ankylosing spondylitis treatments that can reduce the pain and manage the symptoms.
The primary goals of treatment are to improve the quality of life, which are relieving symptoms, maintaining daily life functions, preventing complications and preserving social participation to prevent job loss. There is no one best treatment for AS. Treatment options includes:
- Physical therapy
- Psychosocial support and education
Non-steroidal anti-inflammatory drugs (NSAIDs) are often used as initial therapy because AS responds well to NSAIDs such as naproxen, celecoxib and ibuprofen. Inform your doctor if you have any problems with your heart, kidney and digestive tract before taking NSAIDs. In many cases, NSAIDs are the only medications required. Studies have shown that 80% of individuals with AS who take NSAIDs reported substantial relief of their symptoms, including back pain and stiffness. Usually, NSAIDs are prescribed for 2 to 4 weeks and followed by taken when needed to relieve pain. For additional pain relief, doctors can prescribe non-NSAIDs painkillers like paracetamol.
In cases where NSAIDs do not achieve the desired response, biologic agents may be considered such as tumour necrosis factor (TNF)-alpha inhibitor and interleukin-17 inhibitor. However, TNF-alpha inhibitor is contraindicated if you have medical conditions such as active infection, latent tuberculosis, heart failure, demyelinating diseases and cancer.
For individuals with AS who suffer from persistent pain despite medications, severe limitation in mobility and quality of life, severe deformities that impaired the ability to look forward or with neurologic impairment, hip and spine surgery may be beneficial. Studies have shown that 90% of those who undergo total hip replacement surgery (medically known as total hip arthroplasty), reported pain relief and improved range of motion. Moreover, there is a 90% survival of the replaced hip for 10 years. Meanwhile, spinal surgery is indicated for individuals presented with acute fracture, most commonly the cervical spine fracture. Approximately 25% of cervical fractures are associated with spinal cord injuries. Other surgical procedures include cervical fusion and corrective wedge osteotomy but are only for selected individuals.
Holistic treatment for AS should include physical therapy despite doing well clinically with the medications. The components include postural training, range of motion exercises, stretching, recreational activities, and even strategies to focus on specific needs such as selecting the right mattress and workplace chair. These specific supporting modalities make sense as AS is a disease that affects the spine and its function. Over time, the loss of mobility of the spine is disastrous as it affects the aerobic capacity. If the vertebrae and ribs fuse, the rib cage loses flexibility, making breathing more strenuous. Without regular physical therapy on positioning, a poor posture can also worsen the disease and quality of life. Correcting the habits of movement and positioning in the early stage can help maintain long-term mobility and health. Physical therapists are able to create exercise plans for individuals with AS to maintain mobility and activeness, finding ways to work around their changing mobility, and restoring mobility after they have lost it. The quality of life can be greatly improved when physical therapy empowers individuals in self-management of the disease.
Psychosocial Support And Education
Individuals with AS should receive education regarding the nature of the disease and the importance of regular follow up. Psychosocial support and depression screening help much in mental and moral support. Lifestyle changes like quit smoking are strongly encouraged as smoking causes adverse effects on the recovery of AS.