Coastal Orthopedics Blog

Ankylosing Spondylitis Treatment Options

By:Rob S Williams, MD July 19, 2017 ankylosing spondylitis

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Ankylosing spondylitis  (pronounced AN-kee-low-sing SPON-dil-eye-tiss) is a chronic (long-term) autoimmune disease, similar to rheumatoid arthritis, that primarily affects the lower spine of the more than two million Americans estimated to be afflicted.

 

What are the symptoms of ankylosing spondylitis?

 

Ankylosing spondylitis most commonly starts with pain and stiffness in the lower back—specifically, in the sacroiliac joint, made up of the bones of the bottom of the spine and the pelvis. In advanced cases, pain and loss of flexibility may occur throughout the body. The flares may also become a constant level of discomfort.

 

For those suffering the most severe cases of ankylosing spondylitis, the condition may cause the unwanted growth of new bone. This may result in spinal fusion: the growth of bone in between every vertebra in the spine, closing the natural gaps among them, and resulting in a solid column of bone that is sometimes called "bamboo spine."

 

Is there a cure for ankylosing spondylitis?

 

There is no cure for this condition, which is also known as Bechterew’s disease and Marie-Strumpell disease. Despite evidence that ankylosing spondylitis has been known to humans since the time of the Pharaohs, the specific causes of this disease have yet to be identified.

 

Who is likely to develop ankylosing spondylitis?

 

Men appear more likely to be affected by ankylosing spondylitis than women. Symptoms tend to first appear in people between the ages of 17 and 45. In addition, most people with ankylosing spondylitis carry the HLA-B27 gene. However, none of these factors can definitively predict whether the condition will appear.

 

What is an autoimmune disease?

 

An autoimmune disease causes the body’s immune system to malfunction. Instead of attacking invading bacteria or viruses, the body mistakenly attacks its own normal, healthy tissues. This results in a condition known as inflammation: increased blood flow, swelling, redness, warmth, pain, and stiffness.

 

The inflammation that results from ankylosing spondylitis primarily targets the joints within the spine, particularly at the bottom of the spine and top of the hips. The swelling causes the cartilage caps within those joints to rub against each other, wearing them down and eventually tearing them away.

 

The continued inflammation of AS will actually affect the hard tissues of the skeleton, tricking the body into growing unneeded bone, which results in the fused vertebrae seen in extreme cases of ankylosing spondylitis.

 

Treatments for ankylosing spondylitis

 

With no known cure for ankylosing spondylitis, treatment options are tailored towards helping a patient manage the pain and stiffness, and to slow down the progression of the disease. An early diagnosis of ankylosing spondylitis can maximize the effect of the myriad of treatment options, and prevent or at least delay the onset of extreme symptoms such as permanent joint damage, spinal fusion, kyphosis (abnormal downward curving of the spine), heart disease, and pain throughout the body.

 

Four general types of treatments are available to people suffering from ankylosing spondylitis: physical and lifestyle, medication, surgery, and alternative.

 

Physical and lifestyle treatments for ankylosing spondylitis

  • Maintaining good posture.

    What your grandmother always told you to do—“sit up straight!”—can be essential for managing the symptoms of ankylosing spondylitis. Good posture places the least amount of strain on your spine, and allows all of your body’s components to align properly, both inside and out.

    People suffering any type of pain in their spine naturally tend to slouch, slump, and bend over, seeking relief. Unfortunately, while this may provide immediate temporary relief, it places additional stress on the spine, building to more pain and deeper bending.

    For those suffering from ankylosing spondylitis, good posture may also minimize the long-term problems that accompany spinal fusion. With good posture, the pattern of the bone growth can be directed into a more desirable upright direction.

  • Maintaining a normal body weight.

    There exists what is considered to be an ideal range of body weight for each person, based on height, weight, and age. For example, a 25-year-old male who is 5’10” in height has an ideal weight of as low as 130 pounds to 174 pounds (60-81 kilograms); a 38-year-old female 5’4” in height may range from 108 to 146 pounds (44-60 kg). Note that these recommended weights may vary greatly based on many factors, and are not definitive guides by any means.

    For patients with ankylosing spondylitis, weighing significantly more than the recommend amount will place additional stress on the already-inflamed joints. In addition, the bone loss that may occur with this condition makes the skeleton more susceptible to fractures, which is only increased with additional weight.

    Weighing less than the “ideal” can also cause serious medical problems. While the weight-related stress on joints is lessened, being underweight may result in fatigue, anemia, depression, and more. The inflammation of ankylosing spondylitis can cause a loss of appetite and an inability to keep food down, which in turn may lower the body’s resistance to infection and exacerbate the symptoms of the disease.

  • Heat and cold treatment.

    Just like any sports injury that causes redness, swelling, and pain—aka inflammation—the symptoms of ankylosing spondylitis may be eased temporarily with both heat packs and ice packs.

    Heat may be used to reduce pain, relax muscles, and ease soreness, as warmth will generally increase blood flow to the treated area. Immersing the lower body in a hot bath or taking a hot shower has been shown to be effective in treating the pain of this condition.

    Cold treatments are particularly helpful in reducing swelling and slowing muscle inflammation.

  • Physical therapy.

    Physical therapy is a targeted regimen of specific movements, designed to strengthen a particular muscle or body part. A tailored physical therapy program may include:

    • Stretching/range of motion exercises
    • Proper sleep positioning
    • Proper walking postures
    • Core-strengthening exercises (back and abdominal muscles)

Keeping your body active is particularly effective in combating the symptoms of ankylosing spondylitis. Side benefits include improved posture, maintaining range of motion (especially along the spinal column), pain relief, and improved strength, flexibility, and mobility.

  • Excercising.

    The positive effects of general exercising are the same as those received from physical therapy: posture, flexibility, strength, etc. The difference is that PT targets a specific body area, while exercising benefits the whole body.

    Daily workouts provide the most “bang for the buck”—swimming, particularly doing the breaststroke, seem especially helpful—but even short sessions of 10 minutes are considered beneficial. Best of all, most patients of ankylosing spondylitis report feeling better after exercise. Check with your doctor for the most appropriate exercises for your individual condition.

Medications for ankylosing spondylitis

As ankylosing spondylitis is an autoimmune disease, it may be treated with anti-inflammatory medications. While a pill cannot yet cure the root cause of the ailment, these medications can temporarily ease its pain and discomfort.

 

Several additional medications are currently available for the treatment of ankylosing spondylitis.

  • NSAID (non-steroidal anti inflammatory drugs). Over-the-counter medications such as ibuprofen (Motrin) and naproxen (Aleve) may be administered to relieve inflammation, pain, and stiffness. Indomethacin (Indocin) may also be used. Exceeding recommended dosages may result in bleeding along the gastrointestinal tract, so follow the directions of a physician in taking these.

  • Other pain medications. The OTC drug acetaminophen (Tylenol, Paracetamol, Anacin, etc.) and the naturally occurring opiate codeine are also effective at managing pain. These may be used alone or in combination with an NSAID, but the side effects of codeine may include drowsiness, nausea, constipation, and vomiting.

  • Anti-TNF medication (anti tumor necrosis factor). These injected medications reduce inflammation by blocking the effects of TNF, a chemical produced by the body when tissue is inflamed. This treatment has long been used for people suffering from rheumatoid arthritis, but its long-term effects in patients with ankylosing spondylitis are unknown. Anti-TNF medications may also interfere with the immune system.

  • Corticosteroids are powerful anti-inflammatory medications that resemble the hormone cortisol, which is naturally produced by the adrenal glands. Administered via injection or as tablets, corticosteroids suppress the immune system, reduce the production of chemicals that cause inflammation, and provide relief from pain and swelling. However, they require up to 48 hours to take full effect, and may only be administered a maximum of three times a year, due to the potential for significant side effects such as infection, tendon rupture, or wasting away/degeneration of surrounding muscles, skin, and other tissues.

  • DMARDs (disease modifying anti rheumatic drugs). Normally prescribed for people with rheumatoid arthritis, DMARDs block inflammation, and may target the whole immune system or specific pathways within immune cells. Several weeks are required before benefits may be seen, as DMARDs are not pain medications, and need time to reduce inflammation enough to have a noticeable effect.

 

Alternative treatments for ankylosing spondylitis

Patients suffering from ankylosing spondylitis may choose to explore non-medical treatments for their condition. However, there does not exist any empirical evidence that these treatments have any effect, positive or negative.

  • Books have been written about the benefits of a so-called “anti-inflammatory diet,” which claims that certain foods cause an inflammatory response. By focusing on eating foods that don’t cause inflammation, the conclusion is that the body will benefit in ways similar to taking NSAIDs.

  • Medical professionals caution against using chiropracty, or manual external spinal manipulation, for patients with ankylosing spondylitis. Due to the osteoporosis-like symptoms that accompany severe cases, the spinal bones are more susceptible to fracture, and spinal nerves are more susceptible to damage.

  • An ancient healing art from China, this treatment uses ultra fine needles to puncture the skin and thereby release tension from the underlying muscles, tendons, and other tissues.

  • Another ancient practice, this type of therapy emphasizes breathing, stretching, and flexibility. It may be considered similar to exercise and physical therapy, and should be performed at first with caution to avoid over-extending.

  • Massage Therapy. As this affects the skin and muscles primarily, it does not have any noticeable effect on the inflamed cartilage of the joints. The same medical cautions as chiropracty apply to massage, as those with ankylosing spondylitis already suffer from thinned bones, damaged cartilage, and other internal damage, all of which may be further damaged by massage.

  • Electrical stimulation. Small jolts of electrical current are delivered through the skin via electrodes, somewhat similar to ultrasound therapy. Anecdotal evidence appears to show that e-stim treatment may help with controlling pain, but no formal study supports its use in patients with ankylosing spondylitis.

 

Surgical options for the treatment of ankylosing spondylitis

Despite the pain and discomfort of ankylosing spondylitis, most patients will not require any type of surgery, and those will be largely limited to the most extreme cases. Among the common procedures are the following:

  • Joint replacement. For joints that have become severely damaged and are no longer able to move, or to support the body. Hip replacement surgery is the most common.

  • Spinal surgery. For extreme cases of kyphosis—bending of the spine, particularly in the cervical or neck area—in which breathing and other normal functions are severely impaired, spinal surgery may be recommended to straighten the back and restore some measure of overall back support.

  • This procedure cuts, shaves, and realigns bones that have become deformed as a result of the ankylosing spondylitis, such as the vertebra, ribs, and shoulders.

  • Laminectomy and discectomy. The partial and/or complete removal of portions of the spinal columns, specifically, discs and vertebra. May also involve disc replacement with artificial discs. This procedure is normally used to relieve pressure on the spinal cord, often caused by a herniated disc.

  • Spinal Fusion. The connection, or fusion, of two or more bony components of the spine. Used for the correction of spinal deformities and damage, and the restoration of stability to the spinal column by use of specialized medical hardware (rods, screws, bars, etc.).

If you feel you have any of these signs and symptoms or want to know more about the treatment options of Ankylosing Spondylitis, please call Coastal Orthopedics in Corpus Christi, Texas today at (361) 994-1166.

 

Article written by: Rob Williams, MD

 

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