What Is Ankylosing Spondylitis Remission?

While there is no cure for ankylosing spondylitis, some treatments can help reduce your symptoms and slow the progress of the disease. The goal of treatment is to help people achieve and remain in remission for as long as they can.

Remission is a state of low disease activity. During this time, the progress of the disease slows, and symptoms lessen. When your illness is in remission, you can function better and enjoy a higher quality of life.

This article describes remission in this disease, how to achieve it, and what to expect if symptoms return.

What Does Remission Mean for Ankylosing Spondylitis?

There are no widely accepted standards used to define remission in ankylosing spondylitis. Generally, remission in this and other chronic conditions describes a stage in which there are no signs or symptoms of the disease.

With an ankylosing spondylitis prognosis, the disease is always present in your body, even at the lowest levels of activity in remission, because it is incurable. While ankylosing spondylitis remains present during periods of remission, it is often comparable to the impact of "background noise" during remission. During these periods, you are likely to have minimal physical limitations and pain.

Your rheumatologist (specialist in treating arthritis and other inflammatory diseases) will likely use a combination of functional and clinical assessments and a physical examination to determine whether you are in remission. These assessments are also part of the diagnostic criteria for ankylosing spondylitis.

The following tests for ankylosing spondylitis are used to determine remission:

Bath Ankylosing Spondylitis Disease Activity Index (BASDAI): The BASDAI is considered the gold standard for evaluating disease activity in ankylosing spondylitis. This subjective evaluation requires that you answer six questions related to the degree of problems that you experience from five major disease symptoms:

• Fatigue
• Spinal pain
• Joint pain/swelling
• Areas of localized tenderness
• Duration of morning stiffness
• Severity of morning stiffness

Ankylosing Spondylitis Disease Activity Score (ASDAS): The ASDAS is a composite index that includes the value of blood tests that measure C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR or sed rate), which are objective inflammatory markers. This test also includes a subjective assessment of the following four factors:

• Back pain
• Patient global (overall disease activity)
• Duration of morning stiffness
• Peripheral pain/swelling

Magnetic resonance imaging (MRI) for ankylosing spondylitis: Rheumatologists use magnetic resonance imaging (MRI) to look for early signs of inflammatory lesions in your spine. An MRI can identify signs of sacroiliitis, an inflammation of one or both of your sacroiliac joints at the base of your spine, a common disease symptom.

How to Achieve Remission

While remission is the goal of an ankylosing spondylitis treatment plan, it can be difficult to achieve. You can improve your chances of achieving remission by working closely with your healthcare team to follow your treatment plan.

Your treatment plan is individualized for your personal characteristics, including your age, disease stage, and comorbidities (co-occurring conditions). For most people with ankylosing spondylitis, achieving remission requires a combination of medication, movement, and a healthy lifestyle.

Medication

Several classes of medication are used to treat ankylosing spondylitis. Two types of drugs have been linked with improved remission rates.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are the most commonly used class of medication for ankylosing spondylitis. Because of their analgesic and anti-inflammatory effects, these are often the first-line drugs to treat this condition.

There is also evidence from several studies that long-term use of NSAIDs is linked with disease-modifying effects in ankylosing spondylitis and other forms of spondyloarthritis. While there is little research using remission with NSAIDs as a parameter, there is evidence that some patients can achieve ankylosing spondylitis remission with NSAIDs.

Commonly used NSAIDs include:

• Bayer, Bufferin, Ecotrin, and St. Joseph (aspirin)
• Advil and Motrin (ibuprofen)
• Aleve, Anaprox DS, and Naprosyn (naproxen)
• Celebrex (celecoxib)

Tumor Necrosis Factor (TNF) Inhibitors

TNF inhibitors are biologics, a class of drugs created from living cells. These drugs interfere with the action of inflammation-causing proteins called tumor necrosis factors.

In studies on the effect of TNF inhibitors on advanced ankylosing spondylitis, 17% to 23% of patients achieved partial remission after 24 weeks of treatment. In comparison, the placebo group achieved remission rates of 1.3% to 5.6%.

Other data from a 2019 study indicate that 33% of people with ankylosing spondylitis did not need treatment after five years of using TNF inhibitors.

Each TNF inhibitor works slightly differently, so you may have to try more than one TNF inhibitor before getting the desired results. TNF inhibitors include the following drugs:

• Enbrel, Erelzi, and Eticovo (etanercept)
• Remicade (infliximab)
• Humira, Amjevita, Cyltezo, and Hadlima (adalimumab)
• Cimzia (certolizumab)
• Simponi (golimumab)
  

Healthy Lifestyle

Research indicates that a healthy lifestyle can contribute to improved outcomes among people with ankylosing spondylitis. A 2022 study of how lifestyle factors affected patients with spondyloarthritis linked having two or more unhealthy lifestyle factors with worse physical function, higher disease activity, worse pain and fatigue, and lower quality of life.

The following strategies can help you maintain a healthy lifestyle with ankylosing spondylitis:

• Manage stress with meditation, yoga, or other relaxation techniques to maintain calm
• Consume a healthy, well-balanced diet to help decrease inflammation. and maintain a healthy weight
• Increase your consumption of foods high in antioxidants, like fruits and vegetables
• Avoid foods and beverages that are highly processed and those that contain high amounts of sugar, fat, and salt
• Limit alcohol since it may worsen the symptoms of ankylosing spondylitis
• Quit smoking because smoking is linked with more severe disease activity

Exercise and Physical Therapy

The American College of Rheumatology recommends frequent exercise for people with ankylosing spondylitis as a way to maintain joint health. Research indicates that physical therapy can assist in reducing pain and improving posture, spinal mobility, flexibility, physical functioning, and overall well-being in people with active ankylosing spondylitis.

Regular exercise can help improve posture, pain, fatigue, stiffness, breathing capacity, and overall function in people with ankylosing spondylitis. The Spondylitis Association of America recommends four main types of exercises:

• Stretching or range of motion
• Aerobic or cardiovascular
• Strengthening
• Balance

What Happens After You Reach Remission?

After you reach remission, you may find that you can reduce your treatment dose of medication. Given the high cost and potential side effects of TNF inhibitor therapy, it is beneficial for most people to reduce their dosage of these medications when symptoms subside.

A 2019 study of dose reduction of TNF inhibitors in patients with clinical remission of ankylosing spondylitis showed that reducing the normal dosage to 50% did not change remission status. Study participants maintained low disease activity for a year, whether they were in the group that received the full or half dose of medication.

However, it is important to consult with your rheumatologist before modifying your medication since there isn't a standard definition of remission or a standard definition of what constitutes a reduced dose of medication.

Even though you may be feeling better during remission, the disease is still present. Maintain your treatment plan as advised by your healthcare provider. Continue with healthy lifestyle strategies and exercise to maintain your well-being so you can manage symptoms if they return.

What to Do If Symptoms Return

Ankylosing spondylitis is a chronic disease, so it is not uncommon for symptoms to return after remission. If this occurs, contact your healthcare provider. This is especially important if your medication dose was reduced due to remission.

The return of symptoms may require that you return to a full medication dose or use a combination of medications until your symptoms stabilize.

During this time, maintain your treatment plan as closely as possible to reduce pain and stiffness and offset inflammation.

Pay attention to your emotional as well as physical health. The sudden return of symptoms may leave you feeling like you're not in control, which can lead to depression. Psychotherapy may be useful in helping you learn how to reduce the effect of your pain on aspects of your daily life.

Summary

Ankylosing spondylitis is a lifelong illness that has no cure. The goal of treatment is to help people reach remission and remain in this state for as long as they can.

Remission is described as a state of low disease level, though no standard guidelines define it. During this time, you can function better and enjoy more normal movement. You may have very mild symptoms or none at all, though the disease is still present in your body.

Treatment that includes drugs, movement, and a healthy lifestyle can reduce symptoms and slow the progress of this illness. The effects of some drugs include a higher chance of remission. You may be able to reduce the dose of these drugs if you reach this stage.

A Word From Verywell

While achieving disease remission in ankylosing spondylitis is possible, it can be difficult to do so. Many factors, especially the way you react to a certain drug, can affect your ability to reach this goal.

Don't be discouraged if you're unable to achieve remission. Channel your energies toward following your treatment plan and maintaining your overall well-being. This will help you remain healthy and deal with the inevitable increase and decrease of symptoms that often occur with forms of arthritis.

if you're frustrated by an inability to achieve remission, consider speaking to a mental health professional. Feeling out of control can lead to depression and consequences for your physical health.