Ankylosing spondylitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Physical therapy and exercise, along with medication, are at the most important therapies for ankylosing spondylitis. Physiotherapy and physical exercises preceded by medical treatment in order to reduce the inflammation and pain. NSAIDs, DMARD, and TNFα blockers are the major types of medications used to treat ankylosing spondylitis.
Medical Therapy
No cure is known for AS, although treatments and medications are available to reduce symptoms and pain.
Physical therapy and exercise, along with medication, are at the heart of therapy for ankylosing spondylitis. Physiotherapy and physical exercises are clearly preceded by medical treatment in order to reduce the inflammation and pain, and commonly followed by a physician. This way the movements will help in diminishing pain and stiffness, while exercises in an active inflammatory state will just make the pain worse.
Patients who are able to do so, lie flat on their face or back on the floor for a prescribed cumulative period of time each week, to prevent the chronic stooping which may otherwise result.[1]
Medication
There are three major types of medications used to treat ankylosing spondylitis.
- NSAIDs such as aspirin, ibuprofen, indometacin, naproxen and COX-2 inhibitors, which reduce inflammation and pain. These drugs tend to have a personal response to the pain and inflammation, although commonly used anti-inflammatory drugs like nimesulide are less effective than others;
- DMARDs such as cyclosporin, methotrexate, sulfasalazine, and corticosteroids, used to reduce the immune system response through immunosuppression;
- TNFα blockers (antagonists) such as etanercept, infliximab and adalimumab (also known as biologics), are indicated for the treatment of and are effective immunosuppressants in AS as in other autoimmune diseases;
TNFα blockers have been shown to be the best promising treatment, slowing the progress of AS in the majority of clinical cases. They have also been shown to be highly effective in treating not only the arthritis of the joints but the spinal arthritis associated with AS. A drawback is the fact that these drugs increase the risk of infections. For this reason, the protocol for any of the TNF-α blockers include a test for tubercolosis (like Mantoux or Heaf) before starting treatment. In case of recurrent infections, like even recurrent sore throats, the therapy may be suspended due to the involved immunosuppression.
Physical therapy
All physical therapies must be approved in advance by a rheumatologist, since movements that normally have great benefits on one's health, may harm a patient with AS: massages and physical manipulations should be practiced by therapists familiar with this disease.
- Physical therapy has been shown to be of great benefit to AS patients;
- Swimming is one of the preferred exercises since it involves all muscles and joints in a low gravity environment;
- Slow movements exercises like stretching, yoga, tai chi;
- Any physical movement like, jogging, Pilates method, etc.
References
- ↑ "Remicade.com". Living with Ankylosing Spondylitis. Retrieved 2007-01-11.