The goal of treatment is to relieve your pain and stiffness and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage to your joints.
Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen (Naprosyn) and indomethacin (Indocin, Tivorbex) — are the medications doctors most commonly use to treat ankylosing spondylitis. They can relieve your inflammation, pain and stiffness. However, these medications might cause gastrointestinal bleeding.
If NSAIDs aren't helpful, your doctor might suggest starting a biologic medication, such as a tumor necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor. TNF blockers target a cell protein that causes inflammation in the body. IL-17 plays a role in the body's defense against infection and also has a role in inflammation.
TNF blockers help reduce pain, stiffness, and tender or swollen joints. They are administered by injecting the medication under the skin or through an intravenous line.
The five TNF blockers approved by the Food and Drug Administration (FDA) to treat ankylosing spondylitis are:
- Adalimumab (Humira)
- Certolizumab pegol (Cimzia)
- Etanercept (Enbrel)
- Golimumab (Simponi)
- Infliximab (Remicade)
IL-17 inhibitors approved by the FDA to treat ankylosing spondylitis include secukinumab (Cosentyx) and ixekizumab (Taltz).
TNF blockers and IL-17 inhibitors can reactivate untreated tuberculosis and make you more prone to infection.
If you're unable to take TNF blockers or IL-17 inhibitors because of other health conditions, your doctor may recommend the Janus kinase inhibitor tofacitinib (Xeljanz). This drug has been approved for psoriatic arthritis and rheumatoid arthritis. Research is being done on its effectiveness for people with ankylosing spondylitis.
Physical therapy is an important part of treatment and can provide a number of benefits, from pain relief to improved strength and flexibility. A physical therapist can design specific exercises for your needs.
Range-of-motion and stretching exercises can help maintain flexibility in your joints and preserve good posture. Proper sleeping and walking positions and abdominal and back exercises can help maintain your upright posture.
Most people with ankylosing spondylitis don't need surgery. However, your doctor might recommend surgery if you have severe pain or joint damage, or if your hip joint is so damaged that it needs to be replaced.