Ankylosing Spondylitis

Treatment of Ankylosing Spondylitis

Ankylosing spondylitis cannot be cured, but it can be effectively managed with:

• Medication
• Physical therapy
• Exercise

In addition to your rheumatologist, you may need to see other specialists if you develop related problems:

• Inflammation of the eyes should be treated by an ophthalmologist
• Inflammation of the heart should be treated by a cardiologist

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs) are most often prescribed for ankylosing spondylitis. These include:

• Aspirin (however, aspirin should never be given to children)
• Indomethacin (most people begin with 150 to 200 mg per day)
• Ibuprofen (Motrin, Advil)
• Naproxen (Aleve)

No particular NSAID is proven superior for treating this condition. Each person should use the one he or she finds most effective. NSAIDS can cause an upset stomach or ulcers and should always be taken with food and a full glass of water.

• An antacid or a histamine blocker such as cimetidine may be prescribed to help with stomach upset, but these do not protect against possible damage to the stomach that can be caused by the anti-inflammatory drugs.
• Proton pump inhibitors such as omeprazole and misoprozal provide more protection.

If NSAIDs are not effective, stronger drugs may be prescribed. These include:

• Sulfasalazine, an anti-inflammatory drug (most effective when joints other than the spine are involved)
• Methotrexate, an anti-inflammatory that also suppresses the body’s immune system (most effective when joints other than the spine are involved)
• TNF antagonists, etanercept and remicade, are potent new injectable agents that appear to be dramatically effective in early studies and may be an important advance.
• Corticosteroids (cortisone) may be injected into a joint to relieve inflammation

Oral corticosteroids are usually not prescribed for long periods of time, as they can cause severe osteoporosis (a condition in which bones become thin and weakened) and an increased risk of bone fracture. These drugs also have serious side effects and must be monitored carefully.

Physical Therapy

Physical therapy involves specially designed and monitored exercises. The goal is to help keep the joints flexible and to maintain range of motion.

• Back extension exercises work against the tendency for the spine to curve forward.
• Deep breathing exercises help expand and maintain the capacity of the lungs.
• Therapists also teach proper sleeping and sitting postures.

Exercise

Exercise can be extremely helpful to people with ankylosing spondylitis. A regular exercise program is very important for maintaining strength of muscles and flexibility of joints.

The following exercises are recommended by the National Ankylosing Spondylitis Society in England. Do them once or twice a day, and try to make them part of your normal daily routine. Repeat each of them at least five times.

Floor exercises:

1. Lie on your back with both knees bent and your feet flat on the floor. Lift your hips off the floor as high as possible, hold for five seconds, and lower slowly.
2. Then lift your arms towards the ceiling, with fingers linked together.
3. Keeping your chin tucked in toward your chest, reach both hands toward your knees, lifting your head and shoulders off the floor. Relax.
4. Keeping your chin tucked in, lift your head and shoulders off the floor, and reach both hands towards the outside of your right knee. Repeat to the opposite side.
5. Kneel on all fours. Keeping your elbows straight throughout, tuck your head between your arms and arch your back as high as possible. Then lift your head and round your back the other way as much as possible.
6. Keeping your head up, raise your right arm forward as you raise your left leg backward. Hold for five seconds. Return to all fours and change to raising your left arm and right leg.

Chair exercises:

1. Sit on a stable chair with your feet on the floor, hooked around the legs of the chair. Place your hands by your sides. Hold the chair with your left hand. Bend sideways toward the right as far as possible, without bending forwards, reaching your right hand toward the floor. Repeat to the opposite side.
2. With your hands clasped on your forearms at shoulder level, turn your upper body to the right as far as possible. Repeat to the opposite side.
3. Hold the sides of the chair site. Turn your head to the right as far as possible without letting your shoulders turn. Repeat to the opposite side.
4. Stand facing the chair (for comfort, use one with a padded seat). Place your right heel on the seat, keeping the knee straight, and reach forward as far as possible with both hands toward your foot. Hold for six seconds. Relax. Repeat twice, stretching a little further each time. Repeat with the opposite leg.
5. Face the side of the chair and hold the chair back with your right hand. Bend your right knee and place your right shin on the seat. Place your left foot forward as far as possible. Now place both hands behind your back. Bend your left knee as much as possible, keeping your head up and your back straight. Turn around to face the other side of the chair and repeat with the opposite leg.

Posture exercises:

1. Stand with your back to the wall, shoulders and buttocks against the wall and heels as close to the wall as you can. Tuck your chin in and push the back of your head toward the wall. Keep your shoulders down.
2. Stretch up as tall as possible without lifting your heels. Hold this position. Raise your right arm forward and upward while keeping your elbow straight, your upper arm close to your ear, and your thumb towards the wall. Lower and repeat with the opposite arm.