How to Prevent Pain and Long-Term Damage From Ankylosing Spondylitis

Ankylosing spondylitis (AS) cannot be prevented. However, with proper and prompt diagnosis and treatment, it can certainly be managed. Managing symptoms well decreases the chance for long-term complications.

This article discusses the outlook, treatments, and changes to make to better manage ankylosing spondylitis.

Ankylosing Spondylitis Outlook

While ankylosing spondylitis cannot be prevented, due to advances in modern medicine, it can certainly be managed and well-controlled. People with AS can lead productive, full lives with a normal life span. However, if the disease is left untreated, severe and debilitating long-term complications may develop.

Long-Term Complications

Ankylosing spondylitis primarily targets the spine. When left unmanaged, chronic spine inflammation can lead to spinal fusion. This can lead to decreased mobility and difficulty or inability to bend or twist, motions that are crucial to everyday movement.

Joint fusion can even occur in the region where the ribs meet the spine, leading to difficulty taking deep breaths due to limited chest expansion.

Medical Treatments

Most treatments developed for autoimmune inflammatory illnesses like AS are meant to do the following three things:

• Reduce whole body (systemic) inflammation
• Reduce symptoms such as joint pain and stiffness
• Maintain or improve flexibility and mobility

This can be achieved through various means such as medications, surgery, and physical therapy.

Medication

First-line medication options for AS, as is the case with other autoimmune illnesses like rheumatoid arthritis and psoriatic arthritis, are nonsteroidal anti-inflammatories (NSAIDs). These include but are not limited to:

• Mobic (meloxicam)
• Celebrex (celecoxib)
• Aleve (naproxen)
• Indocin (indomethacin

NSAIDs aim to decrease inflammation within the joints and decrease pain and stiffness. If NSAIDs and physical therapy fail to decrease symptoms and improve a person's condition, biologic medications are the next options.

Biologics aim to suppress the overactive immune system, thus decreasing inflammation throughout the whole body. Biologics target specific markers within the body that are responsible for causing inflammation. Some biologics that can be used for AS are:

• Tumor necrosis factor alpha (TNFa) inhibitors like Humira (adalimumab), Enbrel (etanercept), and Remicade (infliximab).
• Interleukin-17 (IL-17) blockers like Cosentyx (secukinumab) and Taltz (ixekizumab).

It is important to note that since biologic medications suppress the immune system, they can lead to more serious potential side effects than NSAIDs, like recurrent infections and an increased risk of certain types of cancers.

Surgery

Treatment with medications is considered first-line therapy for ankylosing spondylitis. If medications fail to decrease disease progression and permanent joint damage occurs, different surgical options may be considered. While it primarily targets the spine, it can still affect other joints like the hips and knees.

Chronic inflammatory arthritis can lead to joint damage and loss of cartilage. Currently, total hip replacement surgery in people with stable AS and severe hip arthritis is recommended over nonsurgical options.

Depending on the amount and type of damage done to the vertebral column, several surgical options exist, the most common of which is a spinal fusion. While untreated AS can lead to spinal fusion, the surgery fuses two or more vertebrae, often decreasing pain and limiting mobility.

Physical Therapy

Untreated AS can lead to spinal fusion, severely limiting mobility and flexibility of the spine. This can have a huge impact on quality of life. Previously simple tasks like bending to pick something up or even turning your head become difficult or painful to do.

Healthcare providers are very aware of the impact decreased mobility and flexibility of the spine can have on a person's quality of life. They likely will recommend physical therapy early on in treatment.

Routine physical therapy plays a key role in managing AS by reducing disease activity and functional limitations, as well as improving spinal mobility. This can be done at home or with a physical therapist.

Natural Treatments

In addition to medications and surgeries, there are plenty of alternative and lifestyle modifications that can be done to lessen the effects or severity of symptoms from AS.

Exercise and Stretching

Routine and consistent exercise and stretching is a crucial component of managing AS. Regular exercise and stretching, whether done at home, with a physical therapist, or a combination of the two, will maintain or even increase a persons flexibility and mobility.

Routine exercise like walking, yoga, or swimming will also strengthen the muscles supporting the spine and other joints, creating more stability within the body.

 Posture Training

Practicing good posture as much as possible will ensure that the spine is in proper alignment. Poor alignment of the neck and spine can lead to pain, stiffness, headaches, and more. Make sure to keep your computer screen at eye level and the next time you find yourself with your shoulders up to your ears, take a deep breath and roll your shoulders back, straightening up the spine.

 Improve Sleep

Adequate sleep allows the body and mind to rest, recuperate, and repair. Poor sleep quality has been associated with increased levels of inflammation in the body. It is recommended that all people age 18 and up get at least seven hours of sleep per night.

 Lifestyle Changes

There are several lifestyle changes that can help you cope with ankylosing spondylitis.

Diet

There is no diet in particular for AS. However, following a healthy anti-inflammatory diet can help minimize excessive inflammation throughout the body. Avoiding sugary and processed foods is recommended, while eating fatty fish (such as salmon and tuna), vegetables, and fresh fruits is encouraged.

Quit Smoking

Stopping smoking is one of the best and most beneficial things a person can do to improve their overall health and well-being. In addition to increasing a person's risk of developing diseases such as asthma, chronic obstructive pulmonary disease (COPD), and lung cancer, in studies, smoking has been shown to increase AS disease activity.

Limit Alcohol Consumption

While consuming alcohol in moderation can be a treat from time to time, overconsuming alcohol can lead to an increase in systemic inflammation. So, to avoid excessive inflammation and worsening disease, alcohol should be consumed in moderation.

Use Assistive Devices

Depending on the severity of disease and potential lack of mobility, a physical or occupational therapist may be able to recommend assistive devices to improve your quality of life. Assistive devices like canes can offer support and confidence to a person with severe joint disease.

Summary

Ankylosing spondylitis is an inflammatory form of arthritis that predominantly affects the spine and sacroiliac joints. There is no definitive cause for this disease.

Both physical therapy and pharmacotherapy play an important role in the management and treatment of AS. Proper and early management can help prevent long-term and permanent joint damage and complications.