Most people can relate to a feeling of stiff joints in the fingers or in the hips - if only after a long day gardening or sitting in the car. However, stiff joints in the spine, as is the case in a condition called ankylosing spondylitis, may seem a bit more complicated.
Luckily, there are a variety of treatment options for people diagnosed with this progressive form of arthritis, including medications and steps that can be taken at home.
By examining all the options and working with a doctor to move forward, patients can cope with the diagnosis and the condition.
Ankylosing Spondylitis Explained
Ankylosing spondylitis, or AS, is a condition that involves the chronic inflammation of joints located in the spine. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMSD), the term comes from a combination of the Greek words for stiffening of a joint ("ankylos") and vertebra ("spondylo").
NIAMSD reports that the hallmark of the condition is an inflammation of the sacroiliac (SI) joints located where the spine and pelvis meet. Some patients may also have issues with joints in other areas of the body, including hips, shoulders, knees, feet and ribs. In other patients, the points where tendons and ligaments attach to the bones (entheses) are affected, and organs like the eyes, bowels, heart and lungs and can sometimes be involved as well.
The severity of the condition also varies from patient to patient and case to case. According to NIAMSD, many AS patients experience mild back pain episodes that come and go. Other patients have major issues with spine flexibility and experience more severe and constant pain.
"In the most severe cases, long-term inflammation leads to calcification that causes two or more bones of the spine to fuse," explained NIAMSD. "Fusion can also stiffen the rib cage, resulting in restricted lung capacity and function."
Depending on the nature of AS in each particular patients, doctors will work closely with individual patients to develop a treatment plan that best fits. A variety of methods may be used.
According to the Spondylitis Association of America (SAA), treatment may involve a combination of medication, exercise, physical therapy, and steps taken at home like practicing proper posture and using heat and cold to ease pain. In some cases of severe AS, surgery might be needed.
There are a variety of medications that may be used to treat AS, and finding the right option or combination for each individual patient may take some time.
According to SAA, nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common type of medications used to treat AS. NSAIDs aim to treat the stiffness and pain that AS patients commonly cope with.
This type of medication can include over-the-counter pain relievers like ibuprofen (marketed under the brand names Advil and Motrin). SAA pointed out that high doses of NSAIDs can lead to gastrointestinal side effects like stomach irritation, heartburn and over time, ulcers.
"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," explains the SAA. "It is important to note, however, that it may take several weeks for some NSAIDs to show positive results."
If it is decided that a different option is needed, SAA reports that a variety of approaches may be taken. The second line of defense is often a type of drug called disease modifying anti-rheumatic drugs (DMARDs). These drugs, including sulfasalazine, methotrexate and corticosteroids may help with pain and inflammation.
A newer group of medicines, called tumor necrosis factor alpha (TNF-a) blockers have been shown to help treat AS symptoms and inflammation in the spinal joints. Examples of this type of medicine include Humira and Enbrel. Side effects can include an increased risk for infections.
In an interview with dailyRx News, Steve Leuck, PharmD, founder of AudibleRx, highlighted the importance of patience in the AS treatment process.
"Different people respond to different medications with varying levels of effectiveness and it may take some time to find the medication that works best for any particular individual," said Dr. Leuck. "While a patient is working through the process with their doctor of finding the right medication, or combination of medications, it is also important that they maintain close contact with their pharmacist."
Dr. Leuck also noted the importance of following instructions for prescribed medications.
"These categories of medication, (NSAIDs, DMARDS, TNF-a inhibitors) all offer a varying degree of uncomfortable side effects and potential interactions with other medications a patient may be taking," Dr. Leuck told dailyRx News.
"The pharmacist is the final check point before a patient takes their medication home and begins treatment. Receiving a complete medication counseling session with a pharmacist when picking up a medication for AS treatment may help avoid any potentially dangerous drug interactions while also educating the patient about the serious side effects to be aware of," said Dr. Leuck.
A Hands On Approach
Beyond medication, there are steps a patient can take for themselves to help ease AS pain.
According to NIAMSD, "Aside from seeing your doctor regularly and following your prescribed treatment plan, staying active is probably the best thing you can do for ankylosing spondylitis. Regular exercise can help relieve pain, improve posture, and maintain flexibility."
NIAMSD recommends both strengthening exercise and range-of-motion exercises. Exercises aimed at strengthening can help to build up the muscles that surround joints in order to better support the painful areas. Range-of-motion exercises work to ease stiffness and increase flexibility in trouble joints.
Both NIAMSD and SAA stress the importance of seeking professional guidance in regards to starting an exercise program. A patient's doctor or physical therapist can provide guidance.
Another step that patients can take is working on their posture. NIAMSD recommends patients observe their profile in a mirror and work to consciously improve their stance.
"Practicing good posture techniques will also help avoid some of the complications of spondylitis including stiffness and flexion deformities / kyphosis (downward curvature) of the spine," reports SAA.
The SAA also suggests that application of cold and heat may help with pain management. "Applying heat to stiff joints and tight muscles can help reduce pain and soreness. Applying cold to inflamed areas can help reduce swelling," explains the association.
Doctors can provide further suggestions to each patient for what steps to take to cope with their unique case of AS.
Weighing the Options
Again, it is important to note that the severity and symptoms of AS vary greatly from patient to patient, and so the method of treatment will follow suit.
In some cases of severe AS, surgery (like joint replacements) may be required as the patient copes with the condition. However, for most people with AS, it does not come down to this option.
By working closely with both a doctor and a pharmacist and taking steps at home to stay active and ease their pain, patients can move through AS treatment to a life with fewer symptoms and less discomfort.