How to treat ankylosing spondylitis?

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine. While there is no cure, treatments can alleviate symptoms and improve the quality of life for patients. Management strategies include medications, physiotherapy, and, in extreme cases, surgery. Let’s delve deeper into understanding the best methods for treating this condition.

Understanding Ankylosing Spondylitis

Ankylosing spondylitis is a chronic inflammatory condition. It is characterised by pain and stiffness in the spine, and over time can lead to a complete fusion of the vertebrae. Its exact cause is unknown, but it is believed to involve a combination of genetic and environmental factors. The disease usually begins in early adulthood and is more common in men than women.

Progression of Ankylosing Spondylitis

1. Early Stage: In the early stages, symptoms usually start with lower back pain and stiffness. This can be misdiagnosed or brushed off as common back pain.
2. Spinal Fusion: Over time, inflammation can lead to the vertebrae fusing together. This reduces flexibility of the spine and can change posture. Some people develop a forward-stooped posture.
3. Other Joints: AS doesn’t only affect the spine. It can also impact the hips, shoulders, knees, and even smaller joints.
4. Extra-Articular Manifestations: AS can have manifestations outside of the joints, like uveitis (eye inflammation), cardiovascular impacts, and pulmonary issues, to name a few.

Treatment Approaches

1. Medication

• Non-steroidal anti-inflammatory drugs (NSAIDs): Often the first line of treatment, these drugs can reduce pain and inflammation.
• Disease-modifying antirheumatic drugs (DMARDs): Used for patients who don’t respond to NSAIDs. Examples include methotrexate and sulfasalazine.
• Biologics: These target specific proteins involved in the inflammatory process. Examples include adalimumab and etanercept.
• Corticosteroids: Useful for quick relief from symptoms but are not typically used long term due to side effects.

“Medication is often the cornerstone of ankylosing spondylitis treatment, but it’s essential for patients to work closely with their healthcare providers to find the right drug and dosage.”

2. Physical Therapy

Physical therapy plays a pivotal role in managing AS. Regular exercises can maintain flexibility of the spine, improve posture, and strengthen the muscles supporting the spine. A trained physiotherapist can provide a tailored regimen based on the individual’s needs and progression of the disease.

3. Surgery

In extreme cases, when the disease has caused severe joint damage or deformities, surgery might be an option. This could be in the form of joint replacements or procedures to realign the spine.

Lifestyle Changes and Home Remedies

Living with ankylosing spondylitis requires making some adjustments to daily life. Here are some strategies that can make a difference:

1. Maintain good posture: Practising standing and sitting in a straight position can prevent the spine from curving abnormally.
2. Regular exercise: Engage in activities like walking, swimming, or cycling to keep the joints flexible.
3. Heat and cold therapy: Applying heat can relax and soothe muscles, while cold can reduce inflammation.
4. Quit smoking: Smoking can accelerate the progression of AS and reduce lung function.

Will AS Lead to Using a Wheelchair?

• Not everyone with AS will end up in a wheelchair. The progression and severity of AS can vary significantly from person to person.
• With advances in medication, particularly the development of biologic drugs that target specific aspects of the inflammatory process, many people with AS can manage their symptoms effectively and maintain a good quality of life.
• Early diagnosis and treatment can significantly slow the progression of the disease and can potentially prevent severe disability.
• Some individuals with advanced AS may choose to use a wheelchair or other mobility aids at times for convenience or to manage fatigue and pain, but this doesn’t mean they are entirely dependent on them.

Conclusion

While ankylosing spondylitis can be a challenging condition to live with, a combination of medical treatments, physiotherapy, and lifestyle changes can greatly enhance the quality of life for patients. Regular monitoring by a rheumatologist and a proactive approach to treatment can keep the symptoms in check and prevent complications.