Ankylosing Spondylitis

Treatment Guide

Your complete guide to ankylosing spondylitis treatment, symptoms, and disease management.

Topic Guide

What Is Ankylosing Spondylitis?

Symptoms of Ankylosing Spondylitis

What Causes Ankylosing Spondylitis?

Ankylosing Spondylitis Diagnosis

Ankylosing Spondylitis Treatment

Ankylosing Spondylitis Diet

What is Ankylosing Spondylitis?

Ankylosing Spondylitis is a type of inflammatory disease that affects the spine, specifically the joints and ligaments. Also known as axial spondylarthritis or Bechterew’s disease, ankylosing spondylitis causes certain bones in the spine to fuse together. Fused bones in the back may lead to stiffness, pain, and a stooped posture.  

There isn’t a single known cause of the disease. Like other inflammatory conditions, the disease can develop suddenly, with symptoms often first appearing in late adolescence through young adulthood. Most individuals usually develop symptoms before the age of 45. 

Researchers believe there may be a genetic component to ankylosing spondylitis. It is more frequently diagnosed in white males, especially those with the HLA-B27 gene. However, the majority of individuals with this gene do not go on to develop ankylosing spondylitis.  

Symptoms of Ankylosing Spondylitis

Many of the early symptoms of ankylosing spondylitis begin in the lower back. You may experience some, or all of the following ankylosing spondylitis symptoms: 

  • Pain or stiffness in the lower back 
  • Pain in the hips, buttocks, or thighs 
  • Neck pain or discomfort 
  • Fatigue 
  • Fever 
  • Sore feet 
  • GI discomfort 
  • Eye inflammation (uveitis) 

An ankylosing spondylitis specialist or rheumatologist will be able to evaluate your symptoms and rule out other potential diagnoses. 

What Causes Ankylosing Spondylitis?

Ankylosing spondylitis is an autoimmune disease, meaning it occurs when the body’s immune system attacks healthy cells. It first develops in the bones of the spine, where inflammation weakens the area of bone near the edges of the joints. This inflammation may cause pain and stiffness. 

In more advanced cases, the bone may try to repair itself by building new bone tissue. Overtime, this may cause bones in the spine to fuse, creating additional pain, poor posture, and reduced flexibility. Some people may even notice that it’s painful or difficult to take deep breaths due to incorrect positioning of their spine. 

Ankylosing Spondylitis Triggers

Autoimmune disease flares, including ankylosing spondylitis, are often triggered by certain environmental or physical changes. Ankylosing spondylitis triggers may include: 

  • Periods of prolonged stress/anxiety 
  • Infections 
  • Smoking 
  • Pregnancy 
  • Overexertion 
  • Poor sleep 
  • Diet high in inflammatory foods 

Ankylosing spondylitis triggers may be different for each individual. A rheumatologist may be able to help you identify your specific triggers and how to reduce triggers in your daily life. 

Ankylosing Spondylitis Diagnosis

If you are experiencing symptoms of ankylosing spondylitis, your provider will likely conduct an in-office examination and order tests that can help pinpoint the cause of your symptoms. If your PCP suspects you may have ankylosing spondylitis, you will likely be referred to a rheumatologist for further testing.  

Depending on your insurance provider, you may not require a referral to see a rheumatologist for ankylosing spondylitis. Contact your insurer, or reach out to your rheumatologist for more information.

Lab Tests for Ankylosing Spondylitis

There isn’t a single lab test that can diagnose ankylosing spondylitis. Your provider will likely order multiple tests to check for signs of the disease. Certain blood tests can check for inflammatory markers which may be elevated in patients with ankylosing spondylitis. These tests may include: 

  • Erythrocyte sedimentation rate (ESR) 
  • C-reactive protein (CRP) 
  • Procalcitonin (PCT) 

Additionally, your provider may conduct a blood test to check for the presence of the HLA-B27 gene, which is common in many with ankylosing spondylitis. 

Imaging Tests for Ankylosing Spondylitis

Imaging tests, including X-rays or MRIs, can help identify inflammation in the bones and around the joints of the spine. These tests are non-invasive and may accompany other lab tests to help form a diagnosis.  

While an X-ray can diagnose more advanced ankylosing spondylitis, it may not be the best option for early diagnosis. MRIs can diagnose ankylosing spondylitis in the earlier stages, but typically take longer to complete (around 30 minutes) and may be more costly. 

Ankylosing Spondylitis Treatment

Ankylosing spondylitis treatment may involve a combination of medications, physical therapy, and lifestyle changes. Your rheumatologist will work with you to develop a personalized treatment plan for your lifestyle. 

Ankylosing Spondylitis Medications

The medications used to treat ankylosing spondylitis vary depending on the severity of your disease, as well as the existence of other pre-existing medical conditions or medication limitations. 

NSAIDs for Ankylosing Spondylitis

NSAIDs (non-steroidal anti-inflammatory drugs) may be used to combat pain caused by inflammation and swelling. These may include: 

  • Ibuprofen (Advil) 
  • Naproxen (Aleve) 
  • Celecoxib (Celebrex®) 
  • Diclofenac (Cataflam, Dyloject, Zipsor, etc.)

Corticosteroids for Ankylosing Spondylitis

Corticosteroids can help to decrease inflammation and pain in the short term and therefore are best for combating pain related to ankylosing spondylitis flares. Corticosteroids do not treat the underlying cause of ankylosing spondylitis. These medications include: 

  • Prednisone 
  • Methylprednisolone (Medrol) 

These medications are usually taken orally once or twice a day, or as directed by your rheumatologist. 

Biologic Therapy for Ankylosing Spondylitis

Biologic medications are engineered to include live proteins that target specific areas of the immune system that are the root cause of chronic inflammation. Adalimumab (Humira®), Infliximab (Remicade®), Certolizumab (Cimzia®), and Golimumab (Simponi®) are all types of biologic medications administered to treat ankylosing spondylitis. 

Many biologics are given intravenously (IV medications) or injected. If you are prescribed a biologic to treat ankylosing spondylitis, your rheumatologist will help coordinate biologic therapy with an infusion center or a specialty pharmacy. 

Physical Therapy for Ankylosing Spondylitis

Sometimes, physical therapy may be recommended as a treatment for ankylosing spondylitis. A physical therapist may help with strengthening and flexibility exercises that can improve posture, relieve pain, and reduce stiffness.  

Lifestyle Changes During Ankylosing Spondylitis Treatment

Many individuals who have been diagnosed with an autoimmune disease experience improvement in their symptoms by working to reduce daily stress, improving their diets, and practicing good sleep hygiene. All of these changes can help reduce chronic inflammation that exacerbates ankylosing spondylitis symptoms. 

Ankylosing Spondylitis Diet

Anti-inflammatory diets may help improve ankylosing spondylitis symptoms and reduce flares. These diets are rich in anti-inflammatory foods and limit excess amounts of sugar, alcohol, and other highly processed foods. The Mediterranean diet is often a good choice for those looking to incorporate anti-inflammatory meals into their daily routine. 

If you are experiencing symptoms of ankylosing spondylitis or are looking for ankylosing spondylitis treatment in Arizona, our team at Summit Rheumatology is currently accepting new patients. 

Give our team a call at (480) 494-2770 or send us a message to schedule your appointment.