Ankylosing spondylitis is a chronic (rheumatic disease) arthritis condition, but most people who are affected by it are fully independent and lead relatively normal lives. There is no cure for ankylosing spondylitis (AS). Treatment aims to relieve the symptoms, prevent them from interfering with your daily life, and slow their progression.

If your doctor thinks that you have ankylosing spondylitis, chronic (rheumatic disease) arthritis condition, they will prescribe medicines to control your symptoms and you will be referred to a rheumatologist (a specialist in conditions affecting the muscles and joints).

If you are diagnosed with ankylosing spondylitis, your rheumatologist will help you to find the most effective form of pain control and will refer you for further treatment, such as physiotherapy.

There are a number of different treatments that you may have for ankylosing spondylitis, as well as for other conditions that you may also develop. These are outlined below.

Physiotherapy

Physical activity and exercise are very important for effectively treating ankylosing spondylitis, chronic (rheumatic disease) arthritis condition. Keeping active can improve your posture and your range of spinal movement, as well as preventing your spine from becoming stiff and painful.

Your rheumatologist can refer you to a physiotherapist who can advise you about the best ways to exercise and stretch. They will also be able to draw up an exercise plan that is suited to your condition.

As well as activities like stretching, and light exercise, your physiotherapist may recommend some of the following treatments.

Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are a type of painkiller. They are effective in treating ankylosing spondylitis because they help to ease the pain and relieve inflammation in your joints. Examples of NSAIDs are ibuprofen, naproxen and diclofenac.

However, NSAIDs may be unsuitable for you if you have asthma, high blood pressure (hypertension) or kidney or heart problems, or if you have (or have had in the past) stomach problems such as a peptic ulcer. If this is the case, your doctor may prescribe an alternative painkiller, such as paracetamol, with or without codeine.

Tumour necrosis factor (TNF) blockers

If your symptoms of ankylosing spondylitis are not controlled using painkillers and by exercising and stretching, a tumour necrosis factor (TNF) blocker may be recommended for you. TNF is a chemical that is produced by cells when tissue is inflamed.

TNF blockers are given by injection and work by stopping the effects of TNF, helping to reduce the inflammation in your joints that is caused by ankylosing spondylitis. Examples of TNF blockers include etanercept, infliximab and adalimumab.

TNF alpha blockers are a relatively new form of treatment for ankylosing spondylitis, and their long-term effects are unknown. However, research into the use of TNF blockers in rheumatoid arthritis is providing clearer information about their long-term safety.

If your rheumatologist recommends using TNF alpha blockers, your progress will be closely monitored. The main reason for this is that TNF blockers interfere with the immune system.

Bisphosphonates

Although they are usually used to treat osteoporosis (weak and brittle bones), bisphosphonates may also be effective in treating ankylosing spondylitis in cases when other treatments have not worked.

Bisphosphonates can be taken by mouth (orally) as tablets, or given by injection.

Transcutaneous electrical nerve stimulation (TENS)

TENS is a type of therapy that works by numbing the nerve endings in your spinal cord that control pain.

Small electrical pads (electrodes) are applied to the skin over your affected joints, which deliver small pulses of electricity from the TENS machine. Your physiotherapist can control the strength of the pulses and the length of your treatment.

Self-care advice 

If you have been diagnosed with ankylosing spondylitis (AS), chronic (rheumatic disease) arthritis condition, the self care advice outlined below may be useful.

• Make sure that you take the medicines that have been prescribed for you.
• Make sure that you do the stretches and exercises that your physiotherapist has recommended for you.
• Make sure that you have a good posture when sitting and sleeping.
• Do not smoke. As well as having a negative impact on your overall health, smoking is particularly risky for those with ankylosing spondylitis.
• Using hot or cold packs may help to relieve back or joint pain.

Lifestyle changes

If you have ankylosing spondylitis, chronic (rheumatic disease) arthritis condition, you may also have an increased risk of developing cardiovascular disease (conditions that affect your heart and blood flow).

Cardiovascular diseases include heart disease, stroke and deep vein thrombosis (DVT), which is a condition where blood clots develop in your legs.

Your rheumatologist will be able to advise you about any lifestyle changes that you should make in order to minimise your risk of developing a cardiovascular disease. These changes may include:

• giving up smoking (if you smoke),
• losing weight (if you are overweight or obese),
• getting more regular exercise, and
• keeping any other conditions that you may have, such as diabetes, or high blood pressure (hypertension) under control.

Complications of ankylosing spondylitis 

Ankylosing spondylitis, chronic (rheumatic disease) arthritis condition, is a complex condition that can affect many different parts of your body. Some of the conditions that are associated with ankylosing spondylitis are briefly outlined below.

Uveitis

Uveitis, also known as iritis, is a condition that is sometimes associated with ankylosing spondylitis. Uveitis is inflammation of the eyes. If you have the condition, your eyes will become red, painful and sensitive to light.

See your doctor, optician, or optometrist as soon as possible if you have ankylosing spondylitis, and one of your eyes becomes red and painful. Although uveitis is easily treated using eye drops, if it is not treated quickly it can cause the loss of some or all of your vision. However, if uveitis is treated quickly, it usually clears up within two to three weeks.

Osteoporosis

Osteoporosis is a condition that causes your bones to become weak and brittle. In ankylosing spondylitis, osteoporosis can develop in the spine.

Cardiovascular disease

If you have ankylosing spondylitis, your risk of developing a cardiovascular disease, such as heart attacks and stroke, is slightly higher than someone who does not have the condition. Due to the increased risk, it is important to take steps to minimise your chances of developing cardiovascular disease. Your rheumatologist can advise you about lifestyle changes that you can make in order to do this.

Fixed posture

In very severe and rare cases of ankylosing spondylitis, chronic (rheumatic disease) arthritis condition, the pain and stiffness in your lower back can also spread to the upper parts of your spine.

This can decrease the mobility of your spine, making it difficult to move and, as a result, your posture can become fixed in one position. However, it is unlikely that this will cause severe disability unless you also have severe arthritis in your hips.

Spinal fractures

Having ankylosing spondylitis, chronic (rheumatic disease) arthritis condition, increases your risk of developing fractures (breaks) in the vertebrae of your spine. This risk continues to increase with the duration of your condition.

Cauda equina syndrome

Cauda equina syndrome is a very rare complication of ankylosing spondylitis that occurs when the nerves at the bottom of your spine become compressed. Cauda equina syndrome causes symptoms such as pain or numbness in your lower back and buttocks and weakness in your legs, which can affect your ability to walk. Cauda equina syndrome can also make controlling urine and stools (faeces) difficult.

You should see your doctor as soon as possible if you have ankylosing spondylitis and you develop any of these symptoms.

Amyloidosis

Amyloid is a protein that is produced by cells in your bone marrow. Amyloidosis is a condition where amyloid builds up in organs, such as your heart, kidneys and liver.

The symptoms of amylodosis are varied because the condition can affect many different areas of your body. However, in some cases, there may be no symptoms at all.

In very rare cases, it is possible to develop amyloidosis as a complication of ankylosing spondylitis.

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