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Ankylosing spondylitis affects approximately 3.2 million adults in the US. We recently discussed how to diagnose ankylosing spondylitis or “AS.”
Dr. Diana Girnita explains ankylosing spondylitis treatments, including NSAIDs, biologics, and the importance of exercise for managing symptoms.
Key Takeaways
- AS is a chronic, non-curable inflammatory arthritis requiring ongoing management.
- NSAIDs and biologics are effective treatments to control symptoms and inflammation.
- Exercise is a critical component of treatment to maintain mobility and reduce symptoms.
- Untreated AS can cause severe physical disability and increased risk of cardiovascular disease.
- Medical guidance from a rheumatologist is essential for optimal treatment selection.
Summary
- Ankylosing spondylitis (AS) affects about 3.2 million adults in the US and is a chronic inflammatory arthritis impacting the spine, joints, and other organs.
- Early diagnosis is crucial but often delayed; this video focuses on treatment options after diagnosis.
- NSAIDs are the first-line treatment, providing symptom relief for 70-80% of patients; examples include naproxen, diclofenac, meloxicam, and celecoxib.
- Biologic medications target inflammatory proteins TNF-alpha and IL-17, with TNF inhibitors like adalimumab and etanercept commonly used, and IL-17 inhibitors like secukinumab as alternatives.
- AS is not curable but treatment aims to halt disease progression and prevent joint and spinal damage.
- Untreated AS can lead to severe complications such as spinal ankylosis, hip arthritis, kyphosis, osteoporosis, fractures, and increased cardiovascular risks.
- Exercise, including range of motion, stretching, and aquatic therapy, is essential in managing AS and should be guided by a physical therapist.
- Spinal manipulation is contraindicated in patients with spinal fusion or advanced osteoporosis.
- Lifestyle factors like smoking and associated conditions (psoriasis, inflammatory bowel disease) influence disease outcomes.
- Consultation with a rheumatologist is recommended for personalized treatment plans.
Full Transcript — Download SRT & Markdown
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Today we will discuss, can AS be treated? What are the current treatments for AS?
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Is AS reversible or can it be curable? What happens if you don't treat AS?
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How important is exercise in the treatment of AS? Disclaimer: THIS VIDEO IS FOR EDUCATIONAL PURPOSES ONLY AND WILL NOT SUBSTITUTE MEDICAL EVALUATION BY A PHYSICIAN.
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FOR ANY MEDICAL ADVICE, PLEASE CONTACT YOUR PHYSICIAN. Ankylosing spondylitis is a type of inflammatory arthritis that can affect the spine, the peripheral joints, the tendons, but it may affect other organs as well, like the eyes, heart, or kidneys.
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Unfortunately, many patients get diagnosed late, after many years of symptoms. I had a separate video about how to diagnose AS.
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After diagnosis, many patients ask me: Can AS be treated? Yes, nowadays AS has great treatment options.
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In the past, the only therapy available was non-steroidal anti-inflammatory medications. Today we start therapy with non-steroidal anti-inflammatory medications, or as we call these drugs, NSAIDs.
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About 70-80% of patients have great relief in their pain and stiffness symptoms. A few examples of NSAIDs are naproxen, diclofenac, meloxicam, or celecoxib.
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There is no evidence that one NSAID is better than another in treating; however, when researchers looked at the safety profile of these drugs, diclofenac was associated with an increased risk of heart attacks, while naproxen was not.
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What are the current treatments for AS? Besides treatment with NSAIDs, we do have access today to newer treatments.
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These are called “biologic” medications. Biologic medications are more advanced and targeted medications that will block proteins involved in the process of inflammation.
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These molecules are tumor necrosis factor alpha (or TNF-alpha) and interleukin-17 (IL-17). Researchers showed that patients with AS have increased levels of TNF-alpha and IL-17 in their bodies, and these molecules were responsible for creating and maintaining inflammation.
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Based on these findings, new classes of medication to target these molecules have evolved. These are called “biologics.”
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Biologics will block these molecules, and the consequence will be a decreased level of inflammation.
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Most commonly used TNF-alpha inhibitors are adalimumab, etanercept, infliximab, golimumab, and certolizumab. IL-17 inhibitors are a newer class of medication that we use in AS patients.
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If the patients do not respond to TNF-alpha inhibitors or they have contraindications for these drugs, then IL-17 inhibitors are the next in line.
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The most commonly used are secukinumab and ixekizumab. When it comes to choosing a specific treatment, please discuss with your physician who will carefully evaluate your specific medical situation and choose what is appropriate for you.
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This video is for educational purposes and will not offer you medical advice. Is AS reversible or can it be curable?
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Unfortunately, AS is a chronic inflammatory arthritis that is not curable with medication. The role of the medication is to stop the progression of the disease and prevent further damage to the joints or spine.
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Patients that are treated have a lower likelihood of developing severe ankylosis of the spine and becoming disabled.
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There are certain factors that are associated with poor outcomes such as being a smoker, high active disease, male sex, positive HLA-B27, a history of inflammation in the eyes, high C-reactive protein, or if other diseases such as psoriasis or inflammatory bowel disease are associated.
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What happens if you don't treat AS? Unfortunately, many patients with untreated disease will develop many complications from ankylosing of the spine, inability to turn the head, severe hip arthritis, to kyphosis.
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The quality of life is severely impacted by the lack of mobility and chronic pain.
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Patients with untreated AS have an increased risk of osteoporosis, fractures, and also spinal cord injury.
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Chronic persistent inflammation is not only present in the joints but will also affect other organs such as the heart or kidneys.
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Patients with untreated AS have an increased cardiovascular risk and increased risk for heart attacks, strokes, diseases of the aortic root, or venous blood clots.
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How important is exercise in the treatment of AS? Exercise is and should remain an essential part of the treatment plan in patients with AS.
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Exercises should include range of motion exercises, stretching, and aquatic therapy. In my practice, I encourage patients to find a physical therapist who will work with them on a regular basis.
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I have also created an online course that includes a complete guide for nutrition, stress management, exercises, and sleep for patients with inflammatory arthritis like AS.
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I will list the link in the description of this video. However, spinal manipulation should be avoided in patients with spinal fusion or advanced spinal osteoporosis.
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I hope this video answers many of your questions. If you are concerned about ankylosing spondylitis or what is best for you to treat AS, please consult a rheumatologist who will be able to evaluate you further.
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If you like the educational content of this video, don't forget to hit the button below to LIKE, SHARE, and SUBSCRIBE to my channel.
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Thank you!
Topics:ankylosing spondylitisAS treatmentNSAIDsbiologicsTNF inhibitorsIL-17 inhibitorsexercise for ASinflammatory arthritisrheumatologychronic arthritis
