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  • Q&A with Australian Health Practitioners

    What is the treatment for ankylosing spondylitis?

    Related Topics
    Ankylosing Spondylitis Rheumatology
    • 2 answers
    • Dr Aaron Albrecht
    • Dr Irwin Lim
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    Dr Aaron Albrecht

    Chiropractor

    Dr. Aaron Albrecht works at Body Wise Chiropractic in Bibra Lake, Western Australia. The clinic is located within a gym, and Dr. Albrecht is the … View Profile

    Ankylosing spondylitis (AS) is an inflammatory condition and, like many of thise spectrum of disease, has a seemingly random course of relapses and remissions. Manual therapy may aid in retaining some of the flexibility through the joints via mobilisation and manipulation, though these treatments should be gentle considering the inflammatory nature of the condition.

    For symptomatic relief, application of heat packs to stiff joints and tight muscles can reduce soreness and improve motion. Cold packs applied to inflamed areas may also help reduce swelling. Hot showers and baths may also help.

    Ongoing maintainence of good posture is important, to reduce the stress on joint capsules that are affected, a musculoskeletal specialist such as a chiropractor, osteopath or physiotherapist should be able to assist you with this.

    A small study showed that patients who underwent a mixed exercise program of aerobic exercises, stretching and deep breathing exercises exhibited improved physical work capacity and vital capacity, versus those who did not participate (Ince G., Sarpel T., Durgun B., Erdogan S., 2006. Effects of a multimodal exercise program for people with ankylosing spondylitis.). These non-invasive, non-medication therapies are preferred by many due to the fact that they do not have any risk of side effects some medications may carry. In cases where conservative treatment becomes insufficient however, medication may be warranted.

    Medications may also help, including anti-inflammatory drugs or, where these are not sufficient, disease-modifying anti-rheumatic drugs; you should consult your GP or rheumatologist concerning these, as they may have side effects (for instance, pain medications may have intestinal and urinary tract consequences). A new class of drugs has also been showing promising results, these are called TNF blockers, again, you should consult your primary physician regarding these.

    Severe cases may require surgery to correct flexion deformities or replace joints, but this should always be a last resort.

    In all cases it is important to get regular checkups to monitor the progress of your condition, especially in severe cases where cardiac and pulmonary involvement needs to be considered.

    I hope this has shed some light on the matter for you. All the best.

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    Dr Irwin Lim

    Rheumatologist

    Irwin has been a rheumatologist in Sydney since 2003. He is a co-founder and medical director of BJC Health, which consists of a team of … View Profile

    I would agree that there is a key role for exercise, postural improvement, and sometimes, gentle manual therapy.

    AS is an autoinflammatory disorder (with features of immune dysregulation and a genetic predisposition).

    For most patients, anti-inflammatory medication (NSAIDs/Cox2 inhibitors) help symptoms a lot. There is also emerging evidence that these groups of medication may actually slow down the progression of spinal damage.

    Traditional DMARDS (disease-modifying agents) are actually not that useful for this condition, and were typically used due to lack of options, or if there is a peripheral arthritis component (eg affected knees or wrists or other peripheral joints).

    The last decade has seen a revolution in the management of AS.

    For those who do not respond to anti-inflammatory medications (NSAIDs/Cox2 inhibitors) with concomitant exercise, there are now much more effective medications.

    A whole class of medication known as TNF-inhibitors or TNF-blockers.

    TNF has been shown to be a key cytokine/chemical involved in the inflammation of AS (and other spondyloarthritis/spondyloarthropathies such as Psoriatic Arthritis). Medications to block TNF can often lead to dramatic, life-changing improvements.

    This success and excitement has generated a lot more research into the field, so expect to see lots of advances in genetic understanding, pathophysiology, imaging techniques, treatment strategy and actual new therapeutics in the coming years.

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