Spondylitis treatment home remedies

Contents

Medications for Neck Pain Caused by Ankylosing Spondylitis

The sharp, burning neck pain and stiffness caused by progressive ankylosing spondylitis can feel similar to other conditions, such as a muscle strain or herniated disc. However, knowing whether ankylosing spondylitis is causing painful inflammation in the neck can help guide the right treatment plan.

This page covers medications that may be helpful for neck pain caused by ankylosing spondylitis.

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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs help reduce swelling and pain. Some over-the-counter options include ibuprofen and naproxen. NSAIDs are also available as prescription medications in stronger doses or a separate class called COX-2 inhibitors, such as Celebrex. NSAIDs are usually the first type of medication used for treating ankylosing spondylitis.

See NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

Biologics

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Biologic response modifiers help to prevent inflammatory processes in the body.

Unlike conventional drugs, which are manufactured from chemicals, biologics are manufactured from living cells. These medications work by reducing the immune system’s response in cases where it has become overreactive by mistakenly attacking healthy cells.

Read more about The Science Behind Biologics on Arthritis-health.com

While biologics, such as TNF inhibitors and IL inhibitors, can successfully reduce symptoms and possibly slow the progression of ankylosing spondylitis in some people, they also have side effects. For example, due to suppressing some aspects of the immune system, biologics can increase the risk for infection and other illnesses. As such, biologics are typically only tried for ankylosing spondylitis if NSAIDs are ineffective.

Read more about Biologics: Basic Facts for Patients on Arthritis-health.com

Currently, biologics are injected by needle for treating ankylosing spondylitis. In the future, oral options might become available.

In This Article:

  • Neck Pain from Ankylosing Spondylitis
  • Diagnosis of Neck Pain from Ankylosing Spondylitis
  • Treatment of Neck Pain from Ankylosing Spondylitis
  • Medications for Neck Pain Caused by Ankylosing Spondylitis
  • Ankylosing Spondylitis Video

Corticosteroids

In rare cases, oral corticosteroids, such as prednisone, might be used on a short-term basis for treating ankylosing spondylitis. Corticosteroids could be effective at lowering inflammation during a particularly bad flare-up that does not respond to other medications. However, corticosteroids are not recommended for long-term use because of the higher likelihood for serious side effects.

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Medications Not Recommended

Some medications that should not be considered for neck pain caused by ankylosing spondylitis include:

  • Disease-modifying antirheumatic drugs (DMARDs). DMARDs, such as sulfasalazine, are sometimes prescribed for ankylosing spondylitis pain in peripheral joints (located in arms or legs) but not the spine. DMARDs are not effective at treating neck pain that stems from the cervical spine.
  • Corticosteroid injections. While corticosteroid injections may provide temporary relief for radicular pain that stems from the neck, they are not recommended for treating neck or other spinal pain caused by ankylosing spondylitis. For peripheral joints affected by ankylosing spondylitis, such as the hip or knee, corticosteroid injections may be helpful.1

Read more about Ankylosing Spondylitis Medications on Arthritis-health.com

In addition, acetaminophen (Tylenol) is not typically recommended for ankylosing spondylitis, but it may be considered if other medications are ineffective at alleviating the pain.

See Acetaminophen for Back Pain

Ankylosing Spondylitis Symptoms

Ankylosing spondylitis symptoms vary widely. Pain is always a symptom but the location and quality of pain can be different from person to person. Pain is typically accompanied by other symptoms, such as fatigue or eye irritation.

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Watch: Ankylosing Spondylitis Video

Pain and Ankylosing Spondylitis

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Ankylosing Spondylitis
Risk Factors

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Ankylosing Spondylitis
Risk Factors

Many people report pain with stiffness that appears over many months. Pain most often occurs in the:

  • Low back
  • Alternating buttocks
  • Hip(s)
  • Thigh(s)—this is radiating pain that typically does not go past the knee

This pain results from inflammation of the lower spine and/or sacroiliac joints. The sacroilioac joints, sometimes called the iliosacral joints, are where the sacral bone—a triangle shaped bone located at the bottom of the spine—attaches to the ilium bones of the pelvis.

See Possible Causes of Sacroiliitis and SI Joint Pain

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Inflammation of the sacroiliac joint is called sacroiliitis. People with sacroiliitis may notice pain when sitting down or standing up, when climbing stairs, or after a run or strenuous walk.

See Sacroiliac Joint Pain and Inflammation

People with ankylosing spondylitis may also report these pain-related symptoms:

Neck pain. The neck may be painful and/or stiff. Turning the head may be difficult, making certain activities, such as driving, more challenging. While anyone with ankylosing spondylitis can experience neck pain, women tend to report it more frequently than men.

Peripheral joint pain. About half of patients with ankylosing spondylitis develop inflammation of joints in the arms and legs. Peripheral pain and stiffness is most commonly experienced in the:

  • Knee
  • Shoulder
  • Ankle
  • Achilles tendon
  • Plantar fascia (causing pain at the bottom of the heel)

Children with ankylosing spondylitis often report pain in their heels and/or knees, not the low back.

See Juvenile Idiopathic Arthritis and Other Rheumatologic Diseases in Children

Pain and stiffness that improves with exercise. Unlike back pain from other causes, pain from ankylosing is worse during periods of rest or inactivity. Exercise typically helps reduce pain.

See Exercising with Arthritis

Morning stiffness. Affected joints may feel stiff after getting out of bed, and may improve with movement or a warm shower.

Pain that interrupts sleep. Many people report that pain wakes them up, often in the second half of the night.

Tenderness. Many people report tenderness over the area of inflammation. For example, pressing the skin over the base of the spine may be uncomfortable or painful.

Painful flares. Almost everyone with ankylosing spondylitis reports experiencing painful flares—periods of time when symptoms are noticeably worse. Flares can occur suddenly and cause pain and stiffness all over the body. Flares may last days or weeks and are followed by periods of relative relief.

Eye redness and pain. Between 30% and 40% of people with ankylosing spondylitis experience an inflammatory eye condition called uveitis at least once1 (though it is often recurrent). Uveitis, sometimes called iritis, can cause eye redness, eye discomfort, sensitivity to light, and impaired vision. This condition warrants immediate attention by an ophthalmologist.

NSAIDs relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibubrofen and naproxen, usually provide some pain relief to people with ankylosing spondylitis.

See Pain Medications for Arthritis Pain Relief

The location, type, and intensity of pain can vary widely in ankylosing spondylitis.

Other Symptoms Associated with Ankylosing Spondylitis

Ankylosing spondylitis is a systemic disease—it affects the whole body—and pain is not the only symptom. Other symptoms include:

Unexplained fatigue. This body-wide fatigue can be overwhelming and last for days, regardless of how much sleep a person gets.

Fever. A persistent low-grade fever may occur as a result of the body-wide inflammation.

General feeling of illness. Some people report feeling unwell or “not quite right.”

Weight loss and/or loss of appetite. The inflammation may cause people to lose their appetite and lose weight, similar to when having a cold or flu.

Swollen fingers or toes. Dactylitis, the medical name for swollen fingers or toes, can be a sign of ankylosing spondylitis or another type of a spondyloarthritis.

See Understanding the Different Names and Classifications for Spondyloarthritis (SpA)

Vascular disease. Experts estimate people with ankylosing spondylitis are 36% more likely to die from vascular disease than the general population.2 Vascular disease includes:

  • Cardiovascular disease, which affects the heart and increases the risk of heart attacks.
  • Cerebrovascular disease, which affects the brain and increases the risk of stroke.

Pulmonary disease. Anyklosing spondylitis can affect the rib cage and the lungs making breathing difficult or uncomfortable.

See 5 Unusual Ankylosing Spondylitis Symptoms

People with ankylosing spondylitis may experience none, one, or all of these symptoms. Symptoms may come and go and tend to lessen with treatment.

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Complications of Severe Ankylosing Spondylitis

People with advanced cases of ankylosing spondylitis may develop a hunched posture, experience bone fractures, or other complications that are explained on the next page. People who receive treatment for ankylosing spondylitis rarely experience these symptoms.

  • 1.Rosenbaum JT. Uveitis in spondyloarthritis including psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease. Clin Rheumatol 2015;34: 999-1002.
  • 2.Haroon NN, Paterson JM, Li P, Inman RD, Haroon N. Patients With Ankylosing Spondylitis Have Increased Cardiovascular and Cerebrovascular Mortality: A Population-Based Study. Ann Intern Med. 2015;163(6):409-16.

Ankylosing spondylitis is a type of arthritis. The condition causes pain and stiffness in the back, and over time it can actually cause the bones in the spine (called the vertebrae) to fuse together. It also causes arthritis between the spine and pelvis, and may also affect other joints. Because it is a long-term inflammatory condition affecting the joints, it is called a spondyloarthropathy, like psoriatic arthritis and reactive arthritis. (1)

The disease is much more common in men than in women (men with the disease outnumber women by about 3 to 1). It is almost as common as another arthritic condition that is more well known: rheumatoid arthritis. Ankylosing spondylitis affects between 0.35 and 1.3 percent of people in the U.S. (2)

Although ankylosing spondylitis can cause severe pain and mobility problems, it can be managed well in many people. By following a few natural lifestyle tips, you may be able to help ease your symptoms and keep the disease from getting worse. (3)

What Is Ankylosing Spondylitis?

Ankylosing spondylitis is a type of arthritis. It causes swelling, pain, and stiffness in the joints, mostly in the back and pelvis. (4) The pain and stiffness is usually worst at the base of the spine where the spine links with the pelvis (called the sacroiliac joints). (5)

In ankylosing spondylitis, the joints — and the ligaments that help the joints move — start to swell. They stop working as well as normal. In some people, the pain and stiffness in the back comes and goes. In others, the pain and mobility limitation is constant and the disease gets worse over time. (6)

When the tissue around the joints gets injured by the disease, it is replaced by new tissue that slowly turns into bone. Over time, this can fuse the joints in the spine together. Eventually, some people with ankylosing spondylitis end up with a spine that is almost entirely fused together, like a single bone. This keeps them from bending, turning or moving the back and neck like normal. (7)

In most people, ankylosing spondylitis symptoms usually appear during the teen or young adult years. It is rare for people over the age of 40 to be diagnosed. Unfortunately, it takes many people a long time to get the right diagnosis — an average of eight years! Since its symptoms can be confused with those of more common types of arthritis, and since the symptoms usually develop slowly, an ankylosing spondylitis diagnosis usually comes after people have seen several different types of doctors. (8)

How do you diagnose ankylosing spondylitis?

While there is no simple ankylosing spondylitis test to confirm a diagnosis, there are several tests and exams you are likely to get if a doctor suspects you have the condition. You can expect these health checks before you are diagnosed: (9)

  • A full physical exam
  • Questions about your medical history
  • Questions about all of your symptoms, even the ones that come and go
  • Lab tests:
    • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to check for inflammation in the body
    • Human leukocyte antigen B27 (HLA-B27) to check for the HLA-B27 protein, which is more common in people with ankylosing spondylitis
  • X-rays or MRI to check your joints for changes

The doctor will look at all of your results and symptoms, as well as other possible causes for your health problems, before making a diagnosis.

Is ankylosing spondylitis an autoimmune disease?

This is a bit more complex than it sounds. The current answer is “sort of.” It is believed that ankylosing spondylitis is both an autoinflammatory and autoimmune condition, since it has features of both types of conditions. (10)

For example, HLA-B27 causes cells to attack your own healthy tissue, which makes it like an autoimmune disease. But the disease is also helped when inflammatory signals are blocked, suggesting it’s an autoinflammatory condition. It is not widely considered an autoimmune disease, but rather an autoinflammatory disease, like psoriatic arthritis. (11)

HLA-B27 Testing

The HLA-B27 test checks for a protein on your white blood cells. HLA-B27 causes the immune system to attack healthy cells. (12) Up to 95 percent of people who do have ankylosing spondylitis are HLA-B27 positive. (13)

The test is a simple blood draw. Your doctor may order the test if he or she suspects your symptoms are caused by an autoimmune or autoinflammatory condition. Your doctor should also help you interpret your test results, but you can find the basics below.

  • What does HLA-B27 negative mean?
    • If you are HLA-B27 negative, it means you don’t have HLA-B27 on your white blood cells.
  • Can you be HLA-B27 negative and still have ankylosing spondylitis?
    • You can be negative for HLA-B27 and still have ankylosing spondylitis. (14)
  • What does HLA-B27 positive mean?
    • If you are HLA-B27 positive, it means you do have some HLA-B27 on your white blood cells. You inherited the HLA-B27 gene from your parents.
  • Can you be HLA-B27 positive and not have ankylosing spondylitis?
    • Not everyone who tests positive for HLA-B27 in the blood has an immune or inflammatory disorder.
    • If you are HLA-B27 positive, you have a 10 percent chance (or less) of developing a spondyloarthritis condition. (15)
    • If you do not have ankylosing spondylitis, you may have a different condition. The presence of HLA-B27 in you blood means you are at greater risk of developing such a disease. (16)

Ankylosing Spondylitis Signs & Symptoms

Ankylosing spondylitis symptoms vary from person to person. In some cases, symptoms start early and are unrelenting and severe. In others, symptoms may be mild or may come and go. Men are more likely to have more severe symptoms than women. (17)

Common signs and symptoms of ankylosing spondylitis include: (18, 19)

  • Pain or stiffness in the lower back or hips
  • Buttock pain
  • Neck pain
  • Fatigue
  • Less often, pain or stiffness in other areas, such as the shoulders, ribs, hands and feet, or heels

Usually, the pain doesn’t start suddenly. It comes on slowly over months or years. It is also common for pain and stiffness to be worse in the morning or after you have been inactive (for example, after sitting at a desk or watching television). (20) Many people with ankylosing spondylitis feel better after they start moving.

In advanced disease, ankylosing spondylitis causes a stiff, fused spine that makes it difficult to move. People with severe anykosing spondylitis may have a stooped posture caused by the fused spine. The condition can also fuse bones in the rib cage and make it hard to breathe. Other complications may include eye inflammation, called uveitis, compressed bones in the spine caused by weakening of the bone, or problems with your heart. (21)

The disease may also cause problems affecting the gut or skin. In rare cases, the main symptom of the disease is swelling in the arms and legs. This type of disease is known as peripheral spondyloarthritis. (22)

Ankylosing Spondylitis Causes & Risk Factors

What is the cause of ankylosing spondylitis?

The exact cause of this condition is unknown. It has both environmental and genetic causes. (23) This means that if someone in your family has it, you are more likely to have it. This is in part due to the HLA-B27 gene, which increases your risk of a diagnosis of ankylosing spondylitis or another spondyloarthritis.

However, you could have a family history of it, carry the HLA-B27 gene and still not develop the disease. (24) This means that there are some factors in your environment that are at play as well in determining whether you get the condition.

What are the risk factors for ankylosing spondylitis?

You are at a greater risk of being diagnosed with ankylosing spondylitis if you are: (25, 26)

  • Male
  • Related to someone with the disease
  • HLA-B27 positive
  • In your teens, 20s, or 30s
  • Ethnically Alaskan, Siberian, Eskimo, Scandinavian Lapps or from another far-north culture
  • Native American, descended from certain tribes in the western U.S. or Canada
  • Diagnosed with a related disease, such as Crohn’s disease, ulcerative colitis or psoriasis

African Americans are less likely than other races to be diagnosed with spondyloarthritis. (27) People with certain combinations of risk factors, such as having a family history of the disease and being HLA-B27 positive, have a greater chance of developing ankylosing spondylitis. (28)

Conventional Treatment

There is currently no cure for ankylosing spondylitis. However, some people with mild disease or early stages of the illness have periods of remission, when symptoms disappear. When ankylosing spondylitis treatment is required, it is aimed at reducing pain and stiffness as well as trying to prevent deformity and limits on your activities.

There are several common types of treatments used to treat the symptoms and prevent disease progression, including: (29, 30)

  • Pain relievers, such as acetaminophen, or opioids such as tramadol
  • Nonsteroidal anti-inflammatory drugs (NSAIDs, used to ease inflammation and stiffness), such as ibuprofen and naproxen sodium (over-the-counter) or indomethacin, diclofenac and celecoxib (prescription)
  • Disease-modifying antirheumatic drugs (DMARDs, used to reduce pain and swelling and possibly prevent further joint damage), such as adalimumab, golimumab, etanercept and infliximab
  • Corticosteroids to ease pain and stiffness in areas other than the spine
  • Joint replacement surgery to help when use of certain joints, such as the hip, are significantly damaged by the disease

Most people start treatment using over-the-counter pain relievers and NSAIDs. If symptoms don’t improve, health care providers may recommend prescription pain or anti-inflammatory drugs, corticosteroids, or DMARDs. Some people may need a combination of drugs to help control pain and increase their joint function.

13 Natural Ways to Manage Ankylosing Spondylitis Self-Care

Natural approaches to self-care are essential in the effective, long-term management of ankylosing spondylitis. They are part of conventional treatment recommendations and the cornerstone to maintaining mobility and limiting pain.

You can follow the natural strategies below to self-manage many symptoms of ankylosing spondylitis:

  1. Exercise
  2. Practice good posture
  3. Participate in physical therapy
  4. Use hot or cold packs
  5. Ask about transcutaneous electrical nerve stimulation (TENS)
  6. Consider acupuncture
  7. Get a therapeutic massage
  8. Eat to reduce pain, inflammation and other symptoms
  9. Ask about folate supplements or probiotics
  10. Avoid potentially harmful supplements and diets
  11. Maintain a healthy weight
  12. Don’t smoke
  13. Use task-related accommodations

These strategies can help relieve symptoms and in some cases may improve your overall health. As always, speak with a doctor before changing your diet or exercise habits drastically, or before taking or stopping any supplements or medications.

Manage ankylosing spondylitis naturally

1. Exercise, exercise, exercise!

Daily physical activity is essential for people with this disease, and can reduce pain, improve mobility and posture, and help you maintain your flexibility. (31) As an added bonus, exercising can help you achieve a healthy weight (see step 11).

Helpful ankylosing spondylitis exercises

Despite the pain and stiffness that comes with ankylosing spondylitis, rest is not the answer. Regular exercise for your back, neck, chest and limbs is critical to maintain your flexibility and mobility. (32) You may also notice that your symptoms decrease after exercise or activity. Benefits of exercise for people with ankylosing spondylitis include increased flexibility, better range of motion, better posture, better sleep, and less stiffness and pain. (33)

The following resources have specific examples of ankylosing spondylitis exercises you can use to help keep yourself in good physical health:

  • Spondylitis Association of America (34)
  • Arthritis Research UK (35)
  • WebMD (36)

2. Practice good posture techniques.

Being diligent about practicing good posture can help prevent spinal fusion in a stooped or deformed position. (37) Not everyone will have fusion in the spine, but practicing good posture can help keep your spine in a position that looks and feels better. Posture exercises should be practiced daily to have the best impact on your spine’s symptoms.

3. Participate in physical therapy.

A formal program with a physical therapist who understands ankylosing spondylitis can help your posture, joint mobility, pain, and ability to participate in activities. (38) It may include working on your posture, strength, flexibility, stretching, breathing, pain management and targeted activities for your needs.

4. Use heat or cold packs.

Warm compresses and heating pads or ice packs may be helpful for the temporary relief of pain and inflammation. (39)

5. Ask about a TENS (transcutaneous electrical nerve stimulation) machine for pain relief.

This may help reduce pain associated with the condition and can sometimes be rented from physical therapy centers or purchased over-the-counter. (40)

6. Consider acupuncture.

Research suggests acupuncture — done by a professional using sterile needles — may safely help reduce pain. (41) More research is needed to understand its full impact on different types of arthritis, however.

7. Get a therapeutic massage from an expert who is familiar with ankylosing spondylitis.

When done with care and an understanding of the individual’s disease, professional massage therapy can reduce stress and may have some temporary positive impacts on pain, stiffness and flexibility. However, some people find that massage can make their symptoms worse, so proceed with caution. (42)

8. Eat to reduce pain, inflammation and other symptoms. (43)

For example, avoid alcohol, get plenty of calcium and vitamin D to support bone health, and eat a diet rich in fruits, vegetables and whole grains. Limit fats, animal products and processed foods, and try to drink eight to 10 glasses of water each day. Work with your health care provider to find other diet options for altering your ankylosing spondylitis symptoms. (44)

Finding the best ankylosing spondylitis diet for you

As with many conditions with autoimmune and auto-inflammatory elements, there are many possible ways that diet can impact your health. Some people find that certain foods or food groups trigger symptoms. Others may find that eating a certain way keeps their ankylosing spondylitis symptoms in check or even in remission. Ask your health care provider about ways to study and tweak your diet to maintain a healthy intake of nutrients and maximize your ankylosing spondylitis-related health.

Research suggests that a low-starch diet may be beneficial for people with ankylosing spondylitis. This is likely because of its ability to reduce inflammation. (45, 46) Low-starch diets may also be referred to as ketogenic or the keto diet, and it is possible that this type of diet may be particularly beneficial when used in conjunction with medical therapy. (47) However, there can be downsides to following a low-carb diet for people with certain health conditions or medications.

Another study suggests that a diet rich in omega-3 fatty acids may decrease disease activity in people with ankylosing spondylitis. (48) Although other research makes it unclear how close a tie exists between omega-3 consumption and disease activity, it does appear to have some impact on disease-related indicators. (49)

9. Ask your doctor if you need folate supplements or probiotics.

Some of the drugs used to treat ankylosing spondylitis can affect your liver and gut. In some cases, taking a folic acid supplement or adding active-culture yogurt and a banana to your daily diet can help your body protect itself against the possible side effects of the drugs. (50)

10. Avoid certain diets or dietary additives.

The Arthritis Foundation reports that diets high in alfalfa, zinc, or copper salts — as well as the “immune power diet” or a diet low in calories, fat and protein — are known to be harmful. (51)

11. Maintain a healthy weight.

Both overweight and underweight people can have complications with their ankylosing spondylitis. Certain medications can impact your weight, and illnesses that often occur at the same time as ankylosing spondylitis can also cause weight gain or loss. (52) Let your health care provider know if you gain or lose weight quickly or if you need help getting to a healthy weight.

12. Don’t smoke.

Ankylosing spondylitis can restrict the movement of your rib cage, making it hard to take deep breaths. (53) That can make the strain of smoking on your lungs even more dangerous than it otherwise is.

13. Use task-related accommodations.

For example, if you have trouble bending to put your shoes on, use a long-handled shoehorn. If walking is challenging, use a cane or walker. Similarly, if you are in stooped or difficult positions during work, adjust the height of your desk or monitor, or alternate your activities as frequently as possible. And if you have other activities that are difficult because of your condition, work with an occupational therapist to find new ways to do them. (54)

Precautions

Ankylosing spondylitis is a chronic disease. That means it lasts a long time — usually a lifetime — once diagnosed. You can minimize symptoms, delay disease progression and optimize your health by following the advice of your health care provider and working hard to take care of yourself in other ways. However, you should not start taking supplements or change your diet drastically without discussing it with a health care professional. Supplements and dietary changes can impact the effectiveness of medications and can affect both your ankylosing spondylitis and other health issues you may have.

Likewise, do not stop or change your medication regimen without speaking with a health care professional. Some medications for ankylosing spondylitis require tapering if you wish to stop taking them, making it risky for you to stop on your own. If you have side effects from a medication or supplement, call your health care provider or seek emergency care if needed.

You should also work with a doctor or physical therapist to find and begin physical activities safely. Because exercise is so essential to your long-term health, make sure you are doing it right by checking in with the experts from time to time.

Chiropractic care is not considered safe for people with ankylosing spondylitis, according to the Spondylitis Association of America. (55) This is because manipulation of the spine can result in injury (such as spinal fracture) or nerve damage, especially if bone fusion has begun.

Ankylosing Spondylitis Key Points

  • Ankylosing spondylitis is a chronic form of arthritis that eventually causes limited mobility of the spine. However, some people go into remission.
  • Symptoms and their severity vary from person to person.
  • There is currently no cure for ankylosing spondylitis. When ankylosing spondylitis treatment is required, it is aimed at reducing pain and stiffness as well as trying to prevent deformity and limits on your activities.
  • Generally, an ankylosing spondylitis prognosis for someone who receives medical therapy and engages in regular physical activity is good. People live with and manage the disease for decades and can usually overcome the pain and mobility limitations without severe limits in their day-to-day lives. (56)
  • By staying physically active, working with a health care professional to find the right treatments for you, and taking good care of your physical health, you should be able to effectively manage your ankylosing spondylitis.

  1. Exercise
  2. Practice good posture
  3. Participate in physical therapy
  4. Use hot or cold packs
  5. Ask about transcutaneous electrical nerve stimulation (TENS)
  6. Consider acupuncture
  7. Get a therapeutic massage
  8. Eat to reduce pain, inflammation and other symptoms
  9. Ask about folate supplements or probiotics
  10. Avoid potentially harmful supplements and diets
  11. Maintain a healthy weight
  12. Don’t smoke
  13. Use task-related accommodations

Read Next: 6 Ways to Improve Scleroderma Symptoms Naturally

How to Sleep Better if You Have Ankylosing Spondylitis

Periods of rest and inactivity can aggravate your ankylosing spondylitis symptoms. This makes sleeping a challenge, as the longer you’re in bed the more pain you may experience.

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Ankylosing spondylitis is most common in males under 35 years of age.
Watch: Ankylosing Spondylitis Video

If you’re tired of being tired, try these 3 tips for sleeping with ankylosing spondylitis:

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Sleep on your back to ease ankylosing spondylitis symptoms

Many people find relief from their ankylosing spondylitis symptoms by sleeping on their back. I tell my patients that the key to sleeping in this position is to maintain the natural curvature of their spine.

Here are a few pointers if you want to give it a try:

  • Avoid a large head pillow. Elevating your neck distorts your spine and can provoke joint pain. Your best option is typically to sleep without a pillow, but if that won’t work for you try purchasing a slim pillow or using a folded towel. In general, you should also avoid tucking pillows under your back or legs.
  • Be persistent. If you’re like most people, you prefer to sleep on your stomach or side. Switching to sleeping on your back may feel awkward at first—but don’t give up after only a few nights. Try it for 2 weeks, and if you still can’t fall asleep then experiment with other sleep positions until you find one that works for you.
  • Purchase a new mattress. Innerspring mattresses often sag as they age—resulting in uneven sleeping surfaces. Do your spine a favor by purchasing a new mattress every 5-7 years, or if your mattress is showing any signs of sagging. You can easily spot sagging areas by taping a piece of taut string across your bed.

As a general rule, a firm mattress is best for people with ankylosing spondylitis. But every person is different, so make sure to visit a mattress store and try out a variety of options. It’s also a smart idea to purchase a mattress with a 30-day return policy in case your new mattress proves to not be as comfortable as you first thought.

See Ankylosing Spondylitis Treatment

Leave your bed if you can’t fall asleep

You can’t force yourself to fall asleep, and staying in bed will likely increase your stress and further aggravate your ankylosing spondylitis symptoms. So, while it may seem counterintuitive, I suggest you get out of bed if you can’t fall asleep within 30 minutes.

See Coping with Chronic Pain and Insomnia

Instead of brooding for hours, engage in a relaxing activity until you feel sleepy. For example, you might try:

  • Reading a book
  • Knitting or crocheting
  • Completing a crossword puzzle
  • Listening to calming classical music

See Therapies for Treating Insomnia

Remember that certain activities can make it harder to fall asleep, so when you get out of bed I suggest you avoid the following:

  • Watching television or using your phone. The blue light from electronics can hinder your sleep by blocking the release of melatonin. Watching the news, texting, or checking Facebook can also overstimulate your brain and increase stress levels.
  • Rigorous exercise. It’s true that certain exercises can relieve your ankylosing spondylitis pain, but rigorous exercise makes it hard to sleep by temporarily raising your heart rate, adrenaline levels, and body temperature. If you’re restless, one exercise option that can help you relax and relieve your pain is light stretching.
  • See Ankylosing Spondylitis Physical Therapy and Exercise

  • Unhealthy eating. Certain foods—such as those containing sugar or high amounts of fat—can keep you awake. If you need to eat something, try a snack that contains protein and calcium—like a glass of milk.
  • See An Anti-Inflammatory Diet for Arthritis

Get checked for sleep apnea

A 2009 study found that people with ankylosing spondylitis are more likely to suffer from obstructive sleep apnea.1 This means that your sleep problems may not be due to your ankylosing spondylitis symptoms. Rather, your airway may be restricted—which leads to shallow or restricted breathing that can cause you to wake up constantly throughout the night.

If you’re always snoring, or if you notice frequent interruptions to your breathing during the night, consult with your doctor about sleep apnea. Sleep apnea is typically diagnosed by way of an overnight sleep study called a polysomnogram.

Common treatments for sleep apnea include:

  • Weight Loss
  • Quitting smoking
  • A facemask connected to a CPAP machine (or continuous positive airway machine)
  • A removable mouthpiece

See Ankylosing Spondylitis Physical Therapy and Exercise

These 3 tips may not alleviate all your ankylosing spondylitis symptoms, but even if they provide you with a few more hours of sleep per week they are worth the time and effort.

Learn more:

Ankylosing Spondylitis Symptoms

What Is Ankylosing Spondylitis?

  • 1.Rheumatology (2009) 48 (4): 433-435.doi:10.1093/rheumatology/kep021First published online: February 17, 2009.

The 10 Worst Side Effects of Ankylosing Spondylitis, and How to Cope with Them

4. Chronic fatigue

Let’s face it: It can be hard to feel like exercising when you’re tired all the time. Dr. Lo advises checking in with your doctor if your fatigue is becoming problematic. “One reason that there is fatigue in AS because AS is an inflammatory problem; treating the underlying problem with medications can sometimes help with the fatigue,” she says. “Additionally, sometimes people can become anemic if they have an ongoing inflammatory problem, so again, it is important to discuss this problem with your rheumatologists and check some basic blood tests.” In addition, don’t push yourself too hard throughout your day. These tips for dealing with fatigue in inflammatory arthritis can help too.

5. Neck stiffness

AS can affect your entire trunk, all the way up to your neck. You want to try to preserve that range of motion using stretching exercises, so you maintain the ability to turn your head. “Working on flexion, extension, as in nodding, lateral rotation, as in shaking your head, and lateral flexion exercises, tilting your head side to side, can be helpful,” Dr. Lo says. Dr. Chan agrees: “The more exercise patients engage in, the less stiff they will be.”

Make sure you don’t slump over at your work space, which can also contribute to stiffness and poor posture.

6. Eye inflammation

Unfortunately, the National Institutes of Health reports that ankylosing spondylitis affects the eyes in up to 40 percent of patients. “AS can cause something called acute anterior uveitis — it usually manifests as a painful red eye. You might have some blurry vision with it, light can be bothersome, and some people can even have headaches,” Chan says. “You need to see an ophthalmologist right away if this happens — and if you don’t have an ophthalmologist, your rheumatologist might be able to help you get to an ophthalmologist ASAP.”

To prevent vision loss or other complications, your eye doctor should give you prescription eyedrops to treat the inflammation. Read more about uveitis symptoms and treatment here.

7. Heel pain

“Patients with AS can have Achilles tendonitis and plantar fasciitis, which can be very uncomfortable,” Dr. Chan says. Plantar fasciitis, an inflammation of connective tissue at the base of the heel, is very common in people with inflammatory arthritis.

Wear supportive, soft-soled shoes (luckily, there are tons of cool sneaker options) and special heel cushions. Although it may hurt to walk, exercise is once again an important treatment — but you don’t have to go it alone. “Physical therapy can be very helpful,” Dr. Chan says, so reach out to a professional for help. Here are more tips for managing arthritis foot pain.

8. Compression fractures

With ankylosing spondylitis disease progression, spinal fractures become more likely. “In AS, the spine can eventually become ankylosed, which means the bones that make up the spine become fused. Instead of acting as many bones that allow bending of the neck and back, eventually, they just act as one bone,” Dr. Lo says. “Once ankylosis has occurred, then sudden movements that previously were easy can then lead to fracture because there is much less mobility in the spine.” People with AS also tend to have weak bones that make them fracture even more easily, so talk to your doctor about having a bone density test. You also want to make sure you’re getting enough calcium and vitamin D for bone health.

If you’re having surgery for an unrelated problem to your ankylosing spondylitis, Dr. Lo notes it’s important to tell your surgeon that you have AS, particularly if it affects your neck, to prevent fractures. “When the anesthesiologist tries to put the tube down the throat of a person with AS who has neck involvement, this can lead to a fracture of the neck and this can be life threatening,” she says. “It is important to inform the anesthesiologist when a patient with AS has an elective or emergent surgery to avoid the sudden movement of the neck that is usually needed to protect the airway.”

9. Intestinal issues

The inflammation that causes AS can also affect the gut. Studies show up to 10 percent of people with AS also have inflammatory bowel disease (IBD). “Ankylosing spondylitis is an autoimmune disease, and there are some autoimmune diseases that also affect the intestinal tract, for example Crohn’s disease or ulcerative colitis,” Dr. Lo says. “In this case, it is critical to get diagnosed properly by a gastroenterologist.” Many of the medications used to treat ankylosing spondylitis overlap with those used to treat inflammatory bowel disease, she says; but you should talk to your doctor if you’re on NSAIDs to manage AS pain, which can worsen IBD.

“It is important to also make sure that your rheumatologist and gastroenterologist are in communication with one another, and that collective decisions are made to best treat a given patient,” Dr. Lo says. Although there’s no one diet that has been proven to help AS or IBD, talk to your doctor or a registered dietitian to help determine if there are any “trigger” foods for you. Eating a well-rounded, Mediterranean-style diet with lots of fruits and veggies, whole grains, beans and legumes, and fish may help promote maintaining a healthy weight and may reduce inflammation as well.

10. Heart problems

Although this is more rare, AS can take its toll on the cardiovascular system. “We think of chronic inflammation as a risk for developing coronary artery disease,” Dr. Chan says. Dr. Lo says there is also an increased risk for aortic regurgitation (a leaky aortic valve).

Talk to your doctor to discuss how the medications you take could affect your risk; an in addition, practice good heart health habits. “Take care to alter the risk factors that are within your control, such as weight, smoking, diet, and exercise,” Dr. Chan says.

Keep Reading

  • 6 Stretches for Ankylosing Spondylitis You Should Do Every Day
  • Seeing a Rheumatologist for Ankylosing Spondylitis: What to Know Before Your First Visit
  • VIDEO: Ankylosing Spondylitis: Misconceptions and Delays in Diagnosis

Ankylosing Spondylitis (AS): Management and Treatment

How is ankylosing spondylitis treated?

At this time there is no known cure. Treatment aims to reduce pain and stiffness, slow progression of disease, prevent deformity, maintain posture, and preserve function.

  • Exercise programs may help. Patients may be referred for a formal physical therapy program. Patients with AS are given daily exercises for stretching and strengthening, deep breathing exercises, and posture exercises to avoid stooping and slumping. Exercising in water might be recommended.
  • Medications are also used to treat AS.
    • Non-steroidal anti-inflammatory drugs (NSAIDs) are traditionally used to control symptoms but patients will often require more aggressive treatment.
    • Steroids, such as cortisone or prednisone, are rarely used, except for injections to a tendon or joint.
    • Sometimes, medications that are normally used for rheumatoid arthritis, such as sulfasalazine or methotrexate, may be used. These appear to be less helpful for the spine disease and mostly help for the peripheral joints (hands, wrists, knees).
    • More recently, these biologics have been approved for AS: etanercept, certolizumab, adalimumab, golimumab, infliximab, and secukinumab. These drugs may not only help symptoms but also slow the progression of the disease. They are only given as IVs or injections (shots).

Surgical options are limited. Sometimes, total replacements of joints such as knees or hips may be helpful.

If the spine curves forward and fuses that way, an osteotomy might be recommended. This surgery, rarely done, cuts the spine and reshapes it.

What are possible complications of ankylosing spondylitis?

Fusion of bones can happen in the spine, or in the rib cage which can severely limit a patient’s mobility. If the rib cage fuses, the person with AS will have limited lung capacity and function.

Complications also depend on what parts of the body is involved. If the eyes are involved; for example, a patient can have loss of vision if untreated.

A serious possible complication would be fractures in a spine that has gone rigid and brittle.

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Ankylosing Spondylitis Medications

Many people who have ankylosing spondylitis take medications to help reduce the inflammation that causes pain and stiffness. What type of medication a doctor recommends will depend on the person’s symptoms and their severity.

There are four types of medications commonly used to treat ankylosing spondylitis: Nonsteroidal anti-inflammatory drugs (NSAIDs), biologics, steroids, and DMARDs. Like all medications, these drugs can cause side effects or interact with other medications. Patients are advised to discuss any drug therapy plan with their health care professional and report side effects.

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are often the first line of defense against ankylosing spondylitis pain. NSAIDs is a broad category of medications that includes:

  1. Over the counter NSAIDs, such as aspirin, ibuprofen, and naproxen.
  2. Prescriptions NSAIDs, which have the same ingredients as over-counter-medications but are packaged in stronger doses.
  3. COX-2 inhibitors, sometimes called coxibs, which are available only by prescription. Celecoxib, sold as Celebrex, is a COX-2 inhibitor.

See Pain Medications for Arthritis Pain Relief

Biologic medications suppress immune system activity, thereby decreasing ankylosing spondylitis disease activity and symptoms. In some people, biologic drugs called TNF-inhibitors (TNF-blockers) as well as certain interleukin (IL) inhibitors appear to do one or more of the following:

  • Slow the progression of the ankylosing spondylitis
  • Treat peripheral joint pain
  • Treat spinal arthritis pain

See Biologics: Basic Facts for Patients

Biologic medications are administered with a needle, either injected under the skin or infused into a vein. Exactly how much and how often a medication must be administered varies significantly depending on the drug and the patient. Some ankylosing spondylitis patients may take medication once a week, while others get an infusion once every 6 weeks.

See The Science Behind Biologics

Currently, there are six FDA-approved biologic medications for ankylosing spondylitis:

These biologic medications are expensive. In addition, they carry potential risks and side effects, including possible infections resulting from a suppressed immune system.

See Risks and Side Effects of Biologics

Oral biologics
Researchers are studying a class of drugs called Janus kinase (JAK) inhibitors, which can be taken orally. In 2016, the FDA approved the JAK inhibitor tofacitinib citrate (XelJanz) for rheumatoid arthritis. Some experts believe it may also be effective in treating other autoimmune diseases, including as ankylosing spondylitis.

See Biologics, Biosimilars, and Interchangeable Biosimilars—What is the Difference?

In This Article:

Steroids

Steroids may be used to control painful eye symptoms or injected into painful joints. Oral steroids, such as oral prednisone, are rarely used to treatment AS or other spondyloarthropathies.

See Cortisone Injections (Steroid Injections)

Disease-modifying antirheumatic drugs (DMARDs)

DMARDs, such as methotrexate and sulfasalazine, may be prescribed to people whose ankylosing spondylitis causes peripheral joint pain, such as pain in the knees, hips or ankles. DMARDs are not effective in treating pain doctors call axial joint pain, including pain in the neck, back, and sacroiliac joint.1

See Sacroiliac Joint Pain and Inflammation

DMARD side effects may include but are not limited to headaches, abdominal bloating, and nausea/vomiting. Patients can develop bone marrow suppression and/or liver toxicity, so it is important for doctors to regularly monitor patient’s blood samples.

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Medications May Change Over Time

Most newly-diagnosed patients are started on NSAID medications. If symptoms are not alleviated within a reasonable window of time, or if the case is severe, the doctor may recommend using another type of medication, usually a biologic. Over months or years, a medication may become less effective or cause unacceptable side effects, and a new medication can be prescribed.

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