There is no cure for ankylosing spondylitis (AS), but treatment can help to control symptoms such as pain and stiffness and reduce disability. The aims of AS treatment include easing pain and stiffness, maintaining the spine as mobile and flexible as possible and reducing deformity and disability.
Medicines for AS
Pain relieving medicines: The painkiller (analgesic) that you will be given depend on the severity of your pain, your overall health and other health problems. Most people are given non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, diclofenac to reduce inflammation and ease pain. You should take your pain relieving medicines as recommended by the doctor to ease pain so that you can do regular exercises without much discomfort. The anti-inflammatory medicines reduce pain, but do not cure the disease or alter the course of the disease. Therefore, your doctor will advise you to take these medicines as and when the pain flares-up and stop taking them when the symptoms ease. Other pain relieving medicines such paracetamol may be used in case of mild pain or along with NSAIDs. It is not as effective as NSAIDs, but has much less side effects.
Biologics: Medications such as etanercept, infliximab, adalimumab etc are the most recent breakthrough not only for the treatment of different types of arthritis but also the spinal arthritis. Currently, these are the most promising medications for treating ankylosing spondylitis. Research suggests that they can significantly improve your quality of life.
Disease-modifying anti-rheumatic drugs (DMARDs): These drugs can modify or slow joint damage and hence, are often prescribed along with NSAIDs. As these drugs are slow to act, they reduce pain, swelling and disease activity slowly over several weeks. Most of them can cause many side effects and therefore, tests are done often to check for possible side effects. Some of the DMARDs used for treatment of AS include methotrexate, hydroxychloroquine, sulfasalazine etc. DMARDs are used when inflammation of joints other than spine (such as the hips, knees, or ankles) becomes a major problem. In most cases, inflammation in these joints may not respond to NSAIDs.
Corticosteroids: They are potent anti-inflammatory drugs that effectively control symptoms such as pain and swelling. They may control symptoms effectively, but the use of steroids can cause several side effects such as poor growth, weight gain, thinning of skin and osteoporosis. Hence, they are not preferred for long term use.
Other treatments: Non-drug approaches for AS include physiotherapy, applying hot or cold packs, transcutaneous electrical nerve stimulation (TENS) and complimentary therapy.
Surgery: Most patients with AS are treated with medications, but patients with severe spine deformity may need surgery. Some people with AS may need a hip replacement when the hip becomes badly affected.
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