Treatments
Table of Contents
Introduction
Medicinal Treatments
Non-Medicinal Treatments
CAM Treatments
Surgery
Side Effects
Introduction
EraseAS.com provides a comprehensive database of research and treatments regarding Ankylosing Spondylits. Beyond what you see on the page, EraseAS.com also maintains a world-wide forum open to AS patients, medical professionals, scientists and people with questions looking for answers. Public exchange of information is the imperative nudge that gets the ball rolling. We here at EraseAS.com are strong believers in the power of free knowledge and welcome everyone to share their discoveries and ideas in our online community.
There have been major advances in the treatment of AS medicinally, holistically and alternatively. Pain and stiffness of the joints is a daily nuisance and should be combated with a routine of medication, exercise and good posture. Don’t expect your symptoms to disappear after popping a few pills – the fight against AS requires a combination of different remedies. Medications reduce the inflammation, and exercise and posture decrease the pain and improve mobility.
There are a wealth of unconventional aides out there that provide relief from the pain and stiffness associated with AS. At the same time there have been wonderful advances in medicinal and therapeutic treatments. Side effects are always a cause for concern and you should check with your rheumatologist before taking anything. In extreme cases, orthopedic surgery to replace joints such as the hips and knees is an option.
EraseAS.com does not endorse any particular treatment, nor do we guarantee a certain result. Our intent is to simply make these different treatments known to the public. The list of treatments should not be used as a substitute to medical advice from a physician.
Medicinal Treatment
Some medications have mild to serious side effects. You should consult with your rheumatologist before taking any over-the-counter and prescription drugs. EraseAS.com provides links to several reputable drug information Web sites for each type of medicinal treatment. We believe that multiple sources are necessary to create a full, un-biased picture of the pros and cons of each medication. Please check our Side Effects section for more information about medicinal treatments.
- Nonsteroidal Anti-Inflammatory Drugs (NSAID): These are the first step in treatment and are the most commonly used class of medication (SAA). NSAIDs help reduce pain and stiffness of the joints associated with AS - they do not change the course of the disease. Some generic forms of the medication can be bought over-the-counter like Ibuprofin while others are through prescription. NSAIDs are generally taken orally and can take several weeks to show results.
A newer category of NSAIDs, called COXIBs, are supposed to reduce the potential of gastrointestinal complications connected to NSAID treatment. The two major drugs - Vioxx and Bextra - were pulled off the market after patients experienced serious side effects ranging from heart attacks to death.
It is imperative you research a medication beforehand and consult your doctor about risks. Taking other medications in addition to a new drug may result in a negative reaction. Medical history, allergies, age and habits can deeply influence a drug's results and side effects.
- Commonly used NSAIDs: Each medication is prescribed to relieve pain, tenderness, inflammation and stiffness associated with arthritis. All forms are taken orally in either tablet or liquid form. Links lead to Drugs.com and Medlineplus.gov for descriptions, uses, side effects and precautions.
- Anti-Rheumatic Drugs: If symptoms are unresponsive to NSAIDs, this form of medication is the second wave in combating inflammation associated with AS. Pain, stiffness and inflammation of the joints other than the spine may not respond to NSAIDs, so these drugs are used in addition to suppress the body’s immune system and relieve inflammation beyond the lower back.
According to Dr. William Shiel, medical author of MedicineNet.com and rheumatologist, research shows that Sulfasalazine and Methotrexate are ineffective when used for spinal conditions that don’t respond to anti-inflammatory medications. As always, discuss with your doctor first the pros and cons of anti-rheumatic drugs and make a personal decision if this treatment is right for you.
- Common forms of Anti-Rheumatic Drugs: Links lead to Drugs.com and Medlineplus.gov for descriptions, uses, side effects and precautions.
- Biologics/TNF Inhibitors: Technically this is the third wave of medications if the other anti-inflammatory treatments do not work. This biologic medicine attacks a messenger protein for inflammation called TNF (Shiel). So far this class of medication has been effective in halting disease progression, decreasing inflammation and even increasing mobility. All three medications are injectable.
TNF Inhibitors basically block a substance called TNF that your body overproduces when you have an immune disease like AS. This class of medication lowers TNF to a normal level, but also lowers your body’s ability to fight off infections.
- Commonly used Biologic/TNF Inhibitors: Links lead to company information sites and Medlineplus.gov.
Non-Medicinal Treatment
These forms of treatment are an integral part to your AS management and should be done on a regular basis. Most exercises can be done anywhere at any time. These all-natural treatments provide relief through movement and physical sensation while decreasing the risk of future complications like kyphosis, stiffness and loss of mobility.
Most non-medicinal aids require movement of the body – a lot to be asked when you’re experiencing pain and stiffness. Stretches and exercises, as long as you do them at least once a day, can be performed at times when you are feeling most flexible – usually not in the morning. Remember not to push yourself too hard and to be good to your body. These forms of treatment will physically make you feel better.
- Physical Therapy: Your physical therapist will create different routines for you to follow including breathing exercises to increase lung expansion (poor chest wall movement is a symptom of AS). You may be told to sleep on a firm mattress – without a pillow – either on your chest or back to prevent spine curvature (Shiel). Aerobic sports and exercise programs that involve flexing the joints and back increase mobility and ease any pain and stiffness.
- Breathing: Deep breathing throughout the day helps maximize chest expansion and lung capacity. Make a conscious effort to breathe in deeply, hold it, and let the air out slowly. Chest bones can fuse during the progression of AS, and deep breathing will help maintain a normal lung capacity.
- Exercise: With the help of a physical therapist or exercise program outlined by your rheumatologist, physical activity can decrease the pain and stiffness in your lower back and joints. Exercising also helps you maintain a full range of spinal movement and increases back flexibility. Swimming is one of the best forms of exercise for AS patients due to its low impact on the back. Some experts believe constant movement can limit the amount of spinal deformity associated with AS (Patient UK).
- The National Ankylosing Spondylitis Society (NASS) provides AS patients a dozen different exercises to improve mobility and ease stiffness and pain. Click here to enter the site.
- Stretching: Just like before partaking in any form of exercise, it’s always smart to stretch your muscles and joints to avoid injury. With AS patients, stretching the back goes one step further and helps minimize the risk of kyphosis and fusion of other joints. Stretching your joints and muscles on a daily basis helps decrease stiffness. This can be done at any point of the day, though later is better than sooner since many people with AS feel exceptionally stiff when first waking up – making stretching more difficult and less effective.
- Posture: Maintaining a constant upright posture is one of the best habits a person living with AS can develop. Whether you’re sitting in your chair at work, driving in the car or hanging out at home – consciously keeping an erect posture is a surefire way to decrease the strain gravity and spine curvature impose on your back. The SAA offers these posture exercises:
- Hold your chin horizontal and parallel to the floor with your neck slightly arched back. Try to hold this position at all times.
- In front of a mirror, stand with your back against a wall to check your posture. No part of your body should actually be touching the wall. Hold the position for fives seconds, relax, and do it again. Check for any change and notify your rheumatologist.
- Lie face down on a hard, flat surface for twenty minutes. Your head can be to the side, resting on your hands or facing down. Try to lie flat and keep your spine as straight as possible.
- Heat: Hot water bottles, warm baths and hot showers can help reduce soreness in stiff joints. Taking a hot shower before exercising or practicing posture technique will ease the strain on joints.
- Cold: Cold packs or cool baths/showers can help reduce swelling.
- Side Notes: Stay away from any form of constricting clothing like corsets and braces. Try sleeping on a firm mattress. Consciously remind yourself to sit and stand upright. Quit smoking immediately.
Complimentary and Alternative Treatments
These types of treatments are "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine" (National Center for Complimentary and Alternative Medicine). Complimentary treatment is used in addition with conventional medicine while alternative treatment is used in place of conventional medicine. It is important to learn about the different procedures and tools used in complimentary and alternative medicine (CAM), and to inform the practitioner of your condition before going ahead with anything.
EraseAS.com does not advocate the use of CAM treatments, nor do we discourage it. Some people experience positive results from these holistic aids while others do not. In short, these are scientifically unproven theories.
The National Center for Complimentary and Alternative Medicine (NCCAM) categorizes CAM treatment into five classes.
- Alternative Medical Systems: Theory and practice separate from conventional medicine.
- Mind-Body Interventions: Interactions between the brain, body, emotions and behavior.
- Biologically Based Therapies: Use of natural substances such as herbs and dietary supplements.
- Manipulative and Body-Based Methods: Movement and manipulation of body parts.
- Energy Therapies: Use of energy and electromagnetic fields.
Different types of CAM treatments include:
- Acupuncture: The stimulation of acupuncture points on the body with needles may lead to relief of pain and is safe if done by a trained professional.
- Chiropractic Aid: Although most doctors do not endorse the use of chiropractic treatment by AS patients, some patients do find it to helpful. According to Khan, AS sufferers should avoid back manipulations due to the fragility of their spine (SAA).
- Massage: Gentle massaging on tender “hot spots” can help relieve soreness due to inflammation and promote well being.
- Yoga: Stretching the lower back and inflamed joints can ease stiffness and pain as long as instruction is provided by a professional. Yoga is also a nice break from routine exercises and can be done with other people, in a class or by yourself.
- Diet: According to NASS, people living with AS should eat plenty of protein found in meat and fish, a daily diet of fruit and vegetables for vitamins and drink milk for calcium. Avoid eating fatty foods and becoming overweight since the extra weight puts strain on your back.
- Aromatherapy: The use of scented candles and oils can help increase health and well-being.
- Ayurveda: Indian technique of disease prevention and treatment through natural substances and use of the body and mind.
- Homeopathy: Individualized treatment that includes small dosage of remedies.
- Osteopathy: Treats the person as a whole rather than the specific symptom.
- Naturopathy: Rather than attacking the specific disease, healers focus on cleansing the entire body.
- Reiki: Transmission of “life-force” energy from practitioner to patient.
- Qi Gong: Meditation and body movement.
For more information on complimentary and alternative medicines, visit the National Center for Complementary and Alternative Medicine (NCCAM).
Unconventional Treatment
These diverse forms of treatments derive from the millions of average Joes, patients, doctors and companies searching for a cure to AS. Some have seen family members and loved ones waste away from the debilitating effects of AS. Others have watched friends suffer from pain and stiffness and slowly lose their mobility. And some are AS patients themselves searching for and developing remedies that provide more relief than what is available in the market. These entrepreneurs are taking the road less traveled.
EraseAS.com takes no responsibility for any side effects, discouraging results or even curative breakthroughs from these remedies. We do not guarantee any type of outcome and have no involvement in the production or distribution of these unconventional aides. Like all other forms of treatments, to take it is a personal decision.
Web sites on various treatments, cures and books regarding AS:
Surgery
Surgery is a serious decision and should be agreed upon mutually by patient and doctor. Before resigning to an invasive procedure, ask your rheumatologist about holistic aids and medicinal treatments as effective management tools. Normally, an AS patient won’t have cause to worry about undergoing a surgical procedure for a while. Disease progression over time may eventually leads to bony fusion or severe inflammation of the joints – making surgery a viable or sole option.
There are different kinds of surgical procedures for people suffering from an arthritic condition. Anything from total joint replacement to knee arthroscopy – surgery has potential benefits and potential risks. The non profit organization The American Academy of Orthopaedic Surgeons (AAOS) is a provider of musculoskeletal education and advocates for better care of patients.
Please click here to learn about joint replacement surgery, preparation and recovery process. Provided by AAOS.
Side Effects
- NSAIDs: Risks include damage to the gastrointestinal tract if taken in high doses and reduction in the protective mucus of the stomach that can lead to heartburn, gastritis, ulcers and bleeding. Antacids and Carafate can neutralize or prevent the production of excess stomach acid to prevent these side effects. Other side effects include cardiovascular problems, dizziness, fluid retention and confusion, stomach upset, nausea, diarrhea, headaches, jaundice, seizers, and ringing in the ears. Consult your doctor and research side effects and potential risks before taking NSAIDs.
- COXIBs: Although these drugs are supposed to reduce the gastrointestinal problems caused by NSAIDs, they can increase the risk of heart attack and death.
- Sulfasalazine: Aching joints, fever, headache, itching, rash, nausea, increased sensitivity to skin and light, diarrhea, stomach pain and low sperm count.
- Methotrexate: This medication has the potential for causing toxicity to the liver which can lead to toxicity of the bone marrow and anemia. Side effects also include oral ulcers, nausea and gastritis. It is necessary to monitor blood counts when taking the medication. The Conchrane Collaboration, an international non-profit ealthcare organization, reviewed Methotrexate for the treatment of AS and found, “There were no statistically significant benefit of Methotrexate in the examined outcomes for AS patients.” (SAA).
- Corticosteroids: Risks range from thinning of the skin and bones, easy bruising, infections, diabetes and destruction of large joints (Shiel).
- Biologics/TNF-Blockers: These drugs lower your ability to fight illnesses, resulting in an increased frequency of infections – especially tuberculosis (SAA). More rare risks include liver injury, blood disorders, leukemia, lymphoma and fatality. These drugs are also rather expensive.
- CAM Treatments: The major side effect is no effect at all or at best a placebo effect. Some forms of CAM aides like massage therapy, yoga and dieting directly influence the physical body and can promote well-being and better health. Other forms of physical contact like chiropractic treatment can actually have detrimental effects. One of the biggest side effects of CAM treatment is relying solely on it without including conventional and non-medicinal treatment to your AS management.
- Unconventional Treatment: One of the greatest risks is the unknown. Without medical research and professional background on the drug or remedy, you don’t know what to expect. Learn as much as you can about the treatment before use.
- Surgery: Side effects occurring after surgery range from infection, blood clots, loosening of the prosthesis (artificial joint), dislocation of the prosthesis, wear on joint replacements, prosthetic breakage and nerve injury.
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