Materiały źródłowe

• #1 Ankylosing spondylitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/diagnosis-treatment/drc-20354813

  The goal of treatment is to relieve pain and stiffness and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage. […] Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others) are the medicines health care providers most commonly use to treat axial spondyloarthritis and nonradiographic axial spondyloarthritis. These medicines can relieve inflammation, pain and stiffness, but they also might cause gastrointestinal bleeding. […] If nonsteroidal anti-inflammatory drugs (NSAIDs) aren’t helpful, your doctor might suggest starting a tumor necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor. These medicines are injected under the skin or through an intravenous line. Another option is a Janus kinase (JAK) inhibitor. Janus kinase (JAK) inhibitors are taken by mouth. These types of medicines can reactivate untreated tuberculosis and make you more prone to infections.

• #2

  https://www.nhs.uk/conditions/ankylosing-spondylitis/treatment/

  There’s no cure for ankylosing spondylitis (AS), but treatment is available to help relieve the symptoms. […] Treatment can also help delay or prevent the process of the spine joining up (fusing) and stiffening. […] In most cases treatment involves a combination of: exercise, physiotherapy, medicine. […] Keeping active can improve your posture and range of spinal movement, along with preventing your spine becoming stiff and painful. […] As well as keeping active, physiotherapy is a key part of treating AS. […] Types of physiotherapy recommended for AS include: a group exercise programme, an individual exercise programme, hydrotherapy. […] You may need painkillers to manage your condition while you’re being referred to a rheumatologist. […] The first type of painkiller usually prescribed is a non-steroidal anti-inflammatory drug (NSAID).

• #2

  https://www.nhs.uk/conditions/ankylosing-spondylitis/treatment/

  If NSAIDs are unsuitable for you or if you need extra pain relief, an alternative painkiller, such as paracetamol, may be recommended. […] If your symptoms cannot be controlled using NSAIDs and exercising and stretching, anti-tumour necrosis factor (TNF) medicine may be recommended. […] Anti-TNF medicines are given by injection and work by preventing the effects of TNF, as well as reducing the inflammation in your joints caused by ankylosing spondylitis. […] Monoclonal antibodies, such as secukinumab and ixekizumab, may be offered to people with AS who do not respond to NSAIDs or anti-TNF medicine. […] JAK inhibitors are a type of medicine that may be offered to people with AS who do not respond to anti-TNF medicine or cannot take it. […] Corticosteroids have a powerful anti-inflammatory effect and can be taken as injections by people with AS.

• #3 Medications Used to Treat Ankylosing Spondylitis | SPONDYLITIS.ORG

  https://spondylitis.org/about-spondylitis/treatment-information/medications/

  There are a number of different types and classes of medications used in the treatment of ankylosing spondylitis and related diseases. […] NSAIDs are the most commonly used class of medication for the treatment of pain and stiffness associated with spondyloarthritis. […] Sometimes, high doses of NSAIDs are needed to maintain relief from the symptoms of ankylosing spondylitis and related diseases. […] Although NSAIDs are commonly the first line of medications used to treat ankylosing spondylitis and related diseases, sometimes they aren’t enough to control the symptoms. […] In severe cases of ankylosing spondylitis or related disease, NSAIDs may only be partially effective or the side effects too severe to continue their use. In this case, a doctor may prescribe one of the following medications.

• #4 Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Treatment & Management: Approach Considerations, Pharmacologic Therapy, Guideline-directed Therapy

  https://emedicine.medscape.com/article/332945-treatment

  Patients suffering from pain and stiffness should use an NSAID as first-line drug treatment up to the maximum dose, taking risks and benefits into account. […] TNFi, interleukin-17 inhibitors (IL-17i) or JAK inhibitors should be considered in patients with persistently high disease activity despite conventional treatments; current practice is to start a TNFi or IL-17i. […] Total hip arthroplasty should be considered in patients with refractory pain or disability and radiographic evidence of structural damage, independent of age; spinal corrective osteotomy in specialized centers may be considered in patients with severe disabling deformity.

• #5 Medications Used to Treat Ankylosing Spondylitis | SPONDYLITIS.ORG

  https://spondylitis.org/about-spondylitis/treatment-information/medications/

  Sulfasalazine is one medication that can be helpful to some people with severe disease. […] Methotrexate can either be taken via a self-injectable shot or orally in tablet form. […] Apremilast (Otezla) is a medication used primarily to treat adults with moderate to severe plaque psoriasis who are candidates for phototherapy or medications. […] While corticosteroids such as prednisone can be effective in relieving inflammation, the side effects of long-term use of systemic corticosteroids can be very severe. […] The tumor necrosis factor alpha (TNF-) inhibitors were the first biologic medications to have shown great promise in treating spondyloarthritis. […] IL-17 inhibitors are another class of biologic medications approved for spondyloarthritis. […] Ustekinumab (Stelara) works similarly to the IL-17 inhibitor, but targets different cytokines: IL-12 and IL-23. […] Janus kinase (JAK) inhibitors, also known as JAKi, are the latest class of synthetic disease-modifying anti-rheumatic drugs that have been proven effective in the treatment of multiple forms of arthritis, including ankylosing spondylitis.

• #6 Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Treatment & Management: Approach Considerations, Pharmacologic Therapy, Guideline-directed Therapy

  https://emedicine.medscape.com/article/332945-treatment

  Regular exercise helps reduce the symptoms and may slow the progress of the disease. […] Pharmacologic treatment for peripheral spondyloarthritis includes the following: Nonsteroidal anti-inflammatory drugs, Corticosteroid injections, Sulfasalazine, TNFi (infliximab, etanercept, adalimumab, certolizumab, golimumab), IL-17i (secukinumab, ixekizumab). […] In 2019, the US Food and Drug Administration (FDA) approved certolizumab for treatment of nr-axSpA with objective inflammation. […] Agents used in the treatment of AS include the following: Nonsteroidal anti-inflammatory drugs (NSAIDs), Sulfasalazine, Tumor necrosis factoralpha inhibitors (TNFi), Interleukin-17A (IL-17A) inhibitors, Corticosteroids, Janus kinase (JAK) inhibitors. […] NSAIDs improve the symptoms of the disease by reducing pain and decreasing inflammation.

• #7 Ankylosing Spondylitis (AS) Treatment Options

  https://www.everydayhealth.com/ankylosing-spondylitis/guide/treatment/

  If you find that NSAIDs don’t provide enough relief, or if side effects become a problem, your doctor may prescribe a TNF alpha-blocker, also known as a TNF inhibitor or anti-TNF drug. […] According to the Spondylitis Association of America, they have been shown to be very effective in the treatment of ankylosing spondylitis. […] The five TNF alpha-blockers approved by the U.S. Food and Drug Administration (FDA) for use in people with ankylosing spondylitis are: Adalimumab (Humira), Certolizumab (Cimzia), Etanercept (Enbrel), Golimumab (Simponi), Infliximab (Avsola, Inflectra, Remicade, Renflexis). […] Another class of biologic drugs that can be used to treat ankylosing spondylitis are called IL-17 inhibitors. […] The two IL-17 inhibitors approved by the FDA for use in people with ankylosing spondylitis are: Secukinumab (Cosentyx), Ixekizumab (Taltz).

• #8 Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Treatment & Management: Approach Considerations, Pharmacologic Therapy, Guideline-directed Therapy

  https://emedicine.medscape.com/article/332945-treatment

  Sulfasalazine is useful in AS patients who do not respond to or who have contraindications to NSAIDs, as well as in those with coexisting inflammatory bowel disease. […] TNF is a cytokine with two identified forms, which have similar biologic properties. […] Agents that inhibit TNF- have proved very effective in the treatment of AS. […] TNFi are indicated after NSAID therapy has failed (two different NSAIDs for one month each). […] Patients should be screened for latent tuberculosis, hepatitis B, and HIV infection before beginning TNFi therapy. […] Oral corticosteroids are occasionally helpful in controlling AS symptoms. […] JAKs are intracellular tyrosine kinases that affect a range of intracellular activity, including the production of inflammatory cytokines. […] The treatment of patients with axSpA should be individualized according to the current signs and symptoms of the disease (axial, peripheral, extra-articular manifestations) and the patient characteristics, including comorbidities and psychosocial factors.

• #9 RINVOQ® (upadacitinib) for Ankylosing Spondylitis (AS)

  https://www.rinvoq.com/ankylosing-spondylitis

  RINVOQ is a prescription medicine used to treat adults with active ankylosing spondylitis when 1 or more medicines called tumor necrosis factor (TNF) blockers have been used, and did not work well or could not be tolerated. […] It is not known if RINVOQ is safe and effective in children with ankylosing spondylitis.

• #10

  https://www.nhs.uk/conditions/ankylosing-spondylitis/treatment/

  Disease-modifying anti-rheumatic drugs (DMARDs) may be prescribed for AS, although they’re only beneficial in treating pain and inflammation in joints in areas of the body other than the spine. […] Most people with AS will not need surgery. However, joint replacement surgery may be recommended to improve pain and movement in the affected joint if the joint has become severely damaged.

• #11 Ankylosing spondylitis | Symptoms, causes, treatments

  https://versusarthritis.org/about-arthritis/conditions/ankylosing-spondylitis/

  A number of treatments can slow it down and treat pain and stiffness. Exercise and close attention to your posture are just as important to keep your spine mobile and help you to live a normal life. […] Painkillers, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are usually the first choice of treatment for ankylosing spondylitis. […] For people who have symptoms that cant be controlled by anti-inflammatories, other drugs are available to help reduce pain or limit the effects of the condition. […] Drugs such as sulfasalazine and methotrexate, can treat arthritis in your arms and legs, although theyre not usually effective for spinal symptoms. […] These drugs, called disease-modifying anti-rheumatic drugs (DMARDs), can reduce the amount of inflammation that happens in your body. This means that as well as treating symptoms, they can help prevent joint damage.

• #12 Ankylosing spondylitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/diagnosis-treatment/drc-20354813

  Physical therapy is an important part of treatment and can provide a number of benefits, from pain relief to improved strength and flexibility. A physical therapist can design specific exercises for your needs. To help preserve good posture, you may be taught: […] Most people with ankylosing spondylitis or nonradiographic axial spondyloarthritis don’t need surgery. Surgery may be recommended if you have severe pain or if a hip joint is so damaged that it needs to be replaced.

• #13 Guide | Physical Therapy Guide to Ankylosing Spondylitis | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-ankylosing-spondylitis

  Physical therapists help people with AS keep their physical function and manage symptoms. They work with patients to maximize their strength, muscle flexibility, joint mobility, posture, movement habits, and physical conditioning. Physical therapy and exercise are considered key elements in treating AS. […] There is no cure for AS. But proper treatment can greatly help to improve quality of life for people living with the disease by improving: […] Medicines help manage the inflammation that causes symptoms. In some cases, total hip replacement and other surgeries can be performed if needed. Doctors may consider surgery if the joints become too stiff and painful to manage with medicine and physical therapy. […] A physical therapist can help people with AS: […] Your physical therapist will develop a treatment plan specific to your condition and goals. It may include:

• #14 Treating Ankylosing Spondylitis | Arthritis Foundation

  https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/taming-high-disease-activity-in-as

  A combination medications and non-drug therapies is the most effective approach to combat symptoms and possibly achieve remission. […] The goal is to achieve remission, which is the complete absence of signs and symptoms of AS. […] For most people, the best way to reach those goals is with a combination of physical therapy (PT), exercise and medication. […] Exercise is essential for everyone with arthritis, but its even more vital in AS, especially if you have high disease activity. […] When it comes to medications, most people with AS start out taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve). […] Theyre usually the only drugs needed for low disease activity. But for higher inflammation levels, you may need to switch to more aggressive therapy with a tumor necrosis factor (TNF) blocker.

• #15 Ankylosing spondylitis | Symptoms, causes, treatments

  https://versusarthritis.org/about-arthritis/conditions/ankylosing-spondylitis/

  Biological therapies are newer treatments that can be very effective for some people with ankylosing spondylitis and related conditions. […] These drugs have a more targeted approach to stop inflammation than the older DMARDs. […] They can also treat painful tendons, for example at the heel, although they arent repeated too often as they can cause tendon weakness. […] Physiotherapy is a very important part of the treatment for ankylosing spondylitis. A physiotherapist can put together a programme of exercises to improve your muscle strength and help you maintain mobility in your spine and other joints. […] Most people with ankylosing spondylitis dont need surgery, although some people may need a hip or knee replacement if these joints are badly affected. This can get rid of pain and improve mobility.

• #16 Surgery for Ankylosing Spondylitis | Neurological Surgery

  https://neurosurgery.weillcornell.org/condition/ankylosing-spondylitis/surgery-ankylosing-spondylitis

  Many cases of ankylosing spondylitis are treated without surgery. These treatments may include anti-inflammatory drugs (NSAIDs), steroids, and drugs, and physical therapy. […] If the disease has progressed to the point that daily activities are severely impaired, then surgery may be an option. […] In extremely rare cases, a procedure called an osteotomy with fusion may be used to straighten the spine and fuse the vertebrae in better alignment. The goal of surgery is to eliminate compression of the nerve roots, and the second is to stabilize and fuse the spine with bone graft, screws, and rods. The most common surgical procedures for ankylosing spondylitis are: […] A laminectomy is performed to relieve pressure on the nerve roots. This surgical procedure involves removing part of the vertebra bone called the lamina in order to relieve pressure on the nerves. […] Fusion may be required in cases of trauma when there is a fracture to the fused spine. This often involves the placement of screws and rods in order to stabilize the spine and allow the fused spine to heal over time.

• #17 10 Ankylosing Spondylitis Natural Treatments: Exercise and More

  https://www.healthline.com/health/ankylosing-spondylitis-natural-treatment

  Theres no cure for ankylosing spondylitis, but stretching, heat therapy, and other natural approaches may help to ease symptoms. […] Both natural and traditional treatments are available to help address AS symptoms. […] Natural treatments may be used alongside traditional AS treatments. […] These 10 natural therapies may help relieve symptoms: […] Stretching helps build flexibility and may reduce pain. Consider adding spine stretches or lower back stretches to your daily routine. […] To reduce stiffness and pain, try applying a hot water bottle or heating pad to the affected area. A warm bath may also help, especially before exercise. […] Applying an ice pack, cold gel pack, or a bag of frozen vegetables to painful joints can help reduce swelling. After exercise, cold therapy may help reduce inflammation.

• #18 10 Ankylosing Spondylitis Natural Treatments: Exercise and More

  https://www.healthline.com/health/ankylosing-spondylitis-natural-treatment

  Acupuncture is a complementary therapy that involves inserting thin needles into specific points in your skin. This is thought to activate your bodys pain-relieving hormones. […] Massage helps you relax. It may also help you feel more flexible or loose so you can exercise or stretch. […] Gentle exercise programs such as yoga can be beneficial for AS because they incorporate stretching. Swimming may also be beneficial because its easy on your joints. […] Practicing good posture is critical with AS since it can affect your back. The Alexander Technique teaches you to be aware of your posture throughout your day. […] Transcutaneous electrical nerve stimulation (TENS) therapy uses an electrical current to manage pain. […] Smoking can increase your risk for greater spine damage from AS. Quitting smoking not only helps reduce AS damage but also improves your overall health.

• #19 Ankylosing spondylitis | Symptoms, causes, treatments

  https://versusarthritis.org/about-arthritis/conditions/ankylosing-spondylitis/

  Medical treatments can help control ankylosing spondylitis. And there are also many things you can do to help improve your symptoms. […] Keeping active and paying attention to your posture can greatly help you minimise the long-term effects of this condition. […] Regular exercise is good for the range of movement of your back and to stop your spine from stiffening. […] If you have ankylosing spondylitis and you smoke, stopping smoking would be one of the best things you can do. […] Having ankylosing spondylitis, or any kind of spondyloarthritis, can make you more at risk of having a heart attack or stroke. It can also cause problems with the lungs, as it can reduce movement of the joints in the chest. […] Complementary and alternative treatments are usually safe. However, you should always talk to your doctor before starting treatment, as there are some risks associated with specific therapies.

• #20

  https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/ankylosing-spondylitis

  In addition to following your treatment plan, there is a lot you can do yourself to help decrease your pain and increase your movement. Physiotherapy, occupational therapy, regular exercise and relaxation techniques are very important parts of your overall treatment plan. […] Exercise is physical activity that involves heavier, repetitive exertion, and is designed to improve or maintain physical fitness. […] While it’s important to keep your joints moving, it’s also important to avoid situations that put excessive stress or strain on your joints, as that can increase your risk of injury and make your joints deteriorate faster. […] Taking a warm shower and using warm packs are great ways to help reduce pain and stiffness. […] There is no conclusive evidence to suggest that what you eat can make arthritis either better or worse. However, being overweight can put excess strain on your joints, including the spine.

• #21 New Treatments for Ankylosing Spondylitis

  https://www.webmd.com/arthritis/features/as-treatments-next

  I have studied and treated ankylosing spondylitis (AS) for almost 10 years. […] Thankfully, we now have many excellent drugs available to treat both axSpA and AS. Almost half of all people respond well to nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen and indomethacin. […] The TNF blockers, given as injections, stop some of these cytokines. […] But in the last several years, the FDA approved two new injectable drugs: ixekizumab (Taltz) and secukinumab (Cosentyx). […] Janus kinase (JAK) inhibitors are the newest class of drugs approved by the FDA to treat ankylosing spondylitis. […] These inhibitors block specific enzymes (JAK1, JAK2, and JAK3) that signal your cells to make more inflammation. […] There are studies underway to develop even more. […] While our treatments get better and better, I tell my patients they arent enough. Lifestyle is key when it comes to controlling symptoms and improving mobility. Daily range of motion and stretching exercises are particularly important. […] Youll also need to exercise regularly, which includes strength and balance activities.

• #22 BIMZELX® | For Treating Adults with Active Ankylosing Spondylitis (AS)

  https://www.bimzelx.com/ankylosing-spondylitis

  More than 4 in 10 people taking BIMZELX saw at least 40% improvement in back pain, stiffness, and spinal inflammation at 16 weeks vs about 2 in 10 taking placebo. […] Many felt at least 40% improvement in back pain, stiffness, and spinal inflammation at 16 weeks. […] Some felt relief of back pain, stiffness, and spinal inflammation after just one dose as soon as 1-2 weeks. […] One study found a lasting reduction of back pain, stiffness, and spinal inflammation at 52 weeks. […] More than 1 in 10 people taking BIMZELX had at least 40% improvement in back pain, stiffness, and spinal inflammation as early as 1-2 weeks. […] Nearly 6 in 10 people continuously taking BIMZELX saw at least 40% improvement in back pain, stiffness, and spinal inflammation at 52 weeks. […] BIMZELX is a prescription medicine used to treat adults with active ankylosing spondylitis.

• #23 Drug treatment of ankylosing spondylitis and related complications: an overlook review – Wang – Annals of Palliative Medicine

  https://apm.amegroups.org/article/view/44842/html

  Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by back pain and progressive spinal stiffness. […] Therefore, antiinflammation is crucial in the management of AS. The goals and principles of AS management is to achieve remission, control disease activity and improve the quality of the life of patients. What is more, drug therapy is still a primary part of AS management. […] There is evidence that multidisciplinary therapy (MDT) is of great value in drug selection and reasonable combination. […] At present, the first line choice for pain relieve is nonsteroidal anti-inflammatory drugs (NSAIDs). Patients with milder symptoms can choose disease-modifying antirheumatic drugs (DMARDs) or biological agents. However, the efficacy of these drugs in relieving AS is limited.

• #24 Drug treatment of ankylosing spondylitis and related complications: an overlook review – Wang – Annals of Palliative Medicine

  https://apm.amegroups.org/article/view/44842/html

  Therefore, the reasonable selection of drugs and multidisciplinary diagnosis and treatment of co-existing diseases are of great significance, which may improve the therapeutic effect and long-term prognosis of AS. […] In fact, drug therapy is still the main means of AS treatment and is effective in improving symptoms. […] NSAIDs are still the first choice for AS treatment and can effectively relieve pain. […] Conventional synthetic DMARDs can alleviate and improve the symptoms to some extent, however, it usually takes months. […] Biological DMARDs are highly effective drugs in achieving remission. […] This kind of drugs usually take effect quickly and have good effects. […] The most commonly used drugs are TNF- inhibitors, including infliximab and cetuzumab. […] Therefore, early cardiovascular disease-related monitoring and prevention in patients with AS can minimize complications.

• #25 Get Ankylosing Spondylitis Treatment Online – TeleMed2U

  https://www.telemed2u.com/rheumatology/ankylosing-spondylitis-as

  Janus kinase inhibitor – used as a last resort when NSAIDs and traditional biologics fail. […] Other treatment options include: […] Physical therapy – helpful with improving range of motion related to stiffness from chronic inflammation and bone fusion. […] Surgery – only used in severe cases where pain cannot be managed with traditional treatments. […] Although ankylosing spondylitis is a chronic condition with no cure, TeleMed2U rheumatologists offer integrative, holistic treatment approaches as well, based upon a S.E.N.S.E. – ible approach: Stress management, Exercise, Nutrition, Sleep positive social Engagements, which not only help you manage your arthritis symptoms with fewer medications, but often helps you to lose weight. […] Early diagnosis and an integrative treatment approach (not only relying on medications) with a qualified health professional continue to be the best method of treatment. Our providers at TeleMed2U are always available to help better manage your ankylosing spondylitis symptoms.

• #26 Ankylosing Spondylitis Treatments: Drugs, Surgery, Physical Therapy, and More

  https://www.webmd.com/ankylosing-spondylitis/treatments-for-ankylosing-spondylitis

  If other treatments don’t work, your doctor may try a drug made from living organisms. These biologics help your immune system block proteins called cytokines responsible for inflammation. […] You should feel better when you treat your inflammation. But it may take some time for you to find the right medicine. If you still hurt, ask your doctors if you should take something just for pain. They can tell you if any over-the-counter or prescription painkillers may help. […] Experts are still trying to find new drugs to reverse AS. They’re also studying how your genes play a role in getting AS. This could lead to new medications. Someday, doctors may be able to give you a treatment tailored just for you.

• #27 Treatment of Ankylosing Spondylitis – Spondylitis Association of America – Ankylosing Spondylitis

  https://spondylitis.org/about-spondylitis/overview-of-spondyloarthritis/ankylosing-spondylitis/treatment-ankylosing-spondylitis/

  A common treatment regimen for the various forms of spondyloarthritis (ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, reactive arthritis, juvenile spondyloarthritis, and undifferentiated spondyloarthritis) involves medication, exercise, physical therapy, good posture practices, and other options such as applying heat/cold to help relax muscles and reduce joint pain. In severe cases, posture correcting surgery may also be an option. […] In 2015, the American College of Rheumatology, along with SAA and the Spondyloarthritis Research and Treatment Network, had published the first U.S. recommendations for the treatment of adults with axial spondyloarthritis (which encompasses ankylosing spondylitis and non-radiographic axial spondyloarthritis.) […] The American College of Rheumatology, the Spondylitis Association of America, and the Spondyloarthritis Research and Treatment Network published updated recommendations for treating ankylosing spondylitis (AS), and non-radiographic axial spondyloarthritis (nr-axSpA).

• #28 Spondyloarthritis: NICE Releases Guidelines on Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1115/p677.html

  All patients diagnosed with axial spondyloarthritis should be referred to a subspecialist for a structured exercise program. […] First-line pharmacologic treatment for axial spondyloarthritis is the lowest effective dose of a nonsteroidal anti-inflammatory drug with continued evaluation and monitoring. […] All patients with axial spondyloarthritis should be referred to a subspecialist for a structured exercise program. First-line pharmacologic treatment is the lowest effective dose of a nonsteroidal anti-inflammatory drug (NSAID) with continued evaluation and monitoring. If the NSAID is not effective after two to four weeks, another NSAID can be tried. The addition of hydrotherapy for pain or referral to a subspecialist for difficulties with daily activities can be considered. […] First-line treatment options include corticosteroid injections for nonprogressive monoarthritis, and standard disease-modifying antirheumatic drugs (DMARDs) can be used for peripheral polyarthritis, oligoarthritis, and persistent monoarthritis. NSAIDs can be added to DMARDs at the lowest effective dose, with continued evaluation and monitoring. Injection and oral corticosteroids in the short term can be added instead of NSAIDs if the NSAIDs are ineffective. For psoriatic arthritis, if the standard DMARD is ineffective at the highest tolerable dose for three months, adding or using a different standard DMARD can be considered. As with axial spondyloarthritis, referral to a subspecialist for difficulties with daily activities can be considered.

• #29 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis | APTA

  https://www.apta.org/patient-care/evidence-based-practice-resources/cpgs/recommendations-for-the-treatment-of-ankylosing-spondylitis-and-nonradiographic-axial-spondyloarthritis

  Physical therapy is strongly recommended for patients with active or stable ankylosing spondyloarthritis. […] The reviewers conditionally recommend active interventions like supervised exercise over passive interventions like massage, ultrasound, and heat.

• #30

  https://www.nhs.uk/conditions/ankylosing-spondylitis/

  There’s no cure for AS and it’s not possible to reverse the damage caused by the condition. However, treatment is available to relieve the symptoms and help delay its progression. […] In most cases treatment involves a combination of: […] exercises carried out individually or in groups to reduce pain and stiffness […] physiotherapy where physical methods, such as massage and manipulation, are used to improve comfort and spinal flexibility […] medicine to help relieve pain and reduce inflammation such as painkillers, anti-tumour necrosis factor (TNF) medication and other forms of biological therapy. […] Surgery is sometimes needed to repair significantly damaged joints or correct severe bends in the spine, but this is uncommon.

• #31 Ankylosing Spondylitis | MedlinePlus

  https://medlineplus.gov/ankylosingspondylitis.html

  There is no cure for AS, but early treatment can help manage symptoms, slow down the disease, and help you lead a more productive life. […] AS has no cure, but treatment may help relieve symptoms, maintain posture, and slow down the disease. Since other parts of your body can be affected by AS, you will likely work with a team of health care professionals for tests, diagnosis, and care. […] Treatment usually includes medicine to help relieve symptoms and keep the disease from getting worse, as well as physical therapy to improve mobility. If AS is severe, surgery may be needed. […] You can help manage your AS symptoms if you: Exercise, Monitor your symptoms, Manage your stress, Use assistive devices as needed, Follow a healthy diet, Stop smoking, or don’t start.

• #32 Ankylosing Spondylitis: Causes, Treatment | HSS Rheumatology

  https://www.hss.edu/condition-list_ankylosing-spondylitis.asp

  It is very important to get an early diagnosis for ankylosing spondylitis, since treatment is needed even for mild and early cases. All patients with AS need to begin a physical therapy regimen as soon as possible, and a significant number need strong medications to quiet the inflammation and keep them functional. […] Its essential for all ankylosing spondylitis patients to engage in physical therapy and home exercise programs, and to strive for proper maintenance of posture and to help maintain maximum possible flexibility. AS stiffens the spine and tends to position the head to be held forward and the lower back to remain in a flexed position. Stretching and exercise regimens aim to reduce all of these tendencies and increase flexibility. […] Medications can be tremendously helpful in relieving pain, restoring mobility, and stopping or slowing disease progression.

• #33 Ankylosing Spondylitis: Causes, Treatment | HSS Rheumatology

  https://www.hss.edu/condition-list_ankylosing-spondylitis.asp

  The great majority of people with ankylosing spondylitis never need surgery for this condition. Surgery is usually considered only when a persons AS has progressed to a point to where a patients mobility is severely impaired due to chronic, debilitating pain or a painful deformity. […] As is true for all types of inflammatory arthritis, ankylosing spondylitis progresses differently on a patient-by-patient basis, and symptoms will vary. […] Again, in common with many other types of inflammatory arthritis, ankylosing spondylitis is not presently curable, but very effective treatments exist. […] Regardless of the medications used in the individual case, the importance of exercise and physical therapy cannot be overstated.

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