Can You Reverse Ankylosing Spondylitis?

Ankylosing spondylitis (AS) is a chronic disease that inflames the joints in your spine. Over time, this damage can cause stiffness and pain, making it hard to move. The damage it causes can't be reversed.

Though there is no cure for this illness, treatment can improve your symptoms. You can reduce joint damage and relieve pain with certain drugs, body movements, and a healthy lifestyle.

The right treatment can also slow or stop the progress of the disease, which can help prevent more damage. Some people reach remission, a state of low or no disease activity, though the illness remains. During this time, the disease has little effect on your daily life.

This article discusses whether you can reverse ankylosing spondylitis, the stages of this illness, and what you can do to slow its progress.

Can You Reverse Ankylosing Spondylitis?

You can't reverse ankylosing spondylitis. The damage this disease causes is considered permanent.

Ankylosing spondylitis begins with inflammation in the sacroiliac joints. These joints sit in the area of the lower back, about 3 inches to the side of your spine. The sacroiliac joints connect your pelvis and your spine. In women, it may present in different areas of the spine.

In the advanced stages of this disease, inflammation can lead to the formation of new bone in the spine, called ankylosis. When this occurs, portions of your spine become fused in a fixed position, making freedom of movement impossible.

Is Ankylosing Spondylitis Curable?

There is no cure for ankylosing spondylitis. Treatments can help reduce symptoms and slow disease progression, but the disease remains. This is the case even if you achieve remission.

The objective of treatment is to achieve remission. The American College of Rheumatology supports the following goals for treatment:

• Reduce symptoms
• Maintain spinal flexibility and normal posture
• Reduce functional limitations
• Maintain the ability to work
• Reduce disease complications

How AS Progresses

Ankylosing spondylitis progresses differently in everyone. However, certain characteristics may predispose you to a worse diagnosis.

In a 2019 study in Arthritis Care & Research on disease progression, the following factors aligned with a high risk of faster and more severe disease progression:

• Male sex
• Disease onset at an early age
• Inflammation of hip joints
• Higher blood inflammation markers at the onset of the disease
• Family members with an advanced progression of ankylosing spondylitis
• Positive response to medication for ankylosing spondylitis, particularly treatment with a tumor necrosis factor (TNF) inhibitor

Citations of research or health authorities use the source's terms for sex or gender.

Stages of Progression

Ankylosing spondylitis is a lifelong disease. Researchers have described three stages of disease progression. The rate at which you advance from one stage to the next varies by individual.

Disease progression in ankylosing spondylitis includes the following stages:

Early Stage Ankylosing Spondylitis

The onset of ankylosing spondylitis can present differently in individuals. Women tend to present more atypical symptoms than men. Diagnosis at this stage can be difficult because the damage isn't always evident in imaging studies. The early stages of ankylosing spondylitis usually occur between the ages of 17–45.

Common symptoms of ankylosing spondylitis include:

• Frequent lower back pain and stiffness which emerges gradually and spreads to the buttocks
• Pain that starts on one side and then progresses to both sides of your back
• Pain in the lower back that lasts for three months or longer
• Pain that worsens with inactivity
• Fatigue
• Mild to moderate anemia (a low number of healthy red blood cells)
• Bowel inflammation
  
• Swollen fingers and toes

Though back pain is the primary characteristic of early ankylosing spondylitis, pain can occasionally begin at a site where a ligament or tendon attaches to the bone. Common sites for this type of pain include the hip, knee, heel, shoulder, ankle, or elbow. This type of pain is more common in juveniles with ankylosing spondylitis.

Progressing Ankylosing Spondylitis

As ankylosing spondylitis progresses, your pain may spread from your lower back and up toward the middle back and neck. At this stage, joint damage is visible on X-rays, making it easier to make a diagnosis at this stage of the disease.

As inflammation spreads, you may experience the following symptoms:

• Heavy chest pain that mimics a heart attack
• Pleurisy (sharp chest pain that worsens with deep breathing or coughing)
• Inflammation of the jaw and inability to fully open your mouth
• Inability to maintain perfect posture in an upright position
  
• Sensitivity to light
• Iritis or uveitis (two types of eye inflammation)
• Irritation of your kidneys or liver

Advanced Ankylosing Spondylitis

Depending on the age of onset and the rate at which your disease progresses, you may not reach the advanced stage of ankylosing spondylitis.

In this stage, irreversible joint damage occurs. This results from new bone growth between your vertebrae, which causes the bones of the vertebrae to join together with the following effects:

• The development of "bamboo spine," visible on imaging tests
• Kyphosis (an exaggerated curve in the middle of your spinal column)
• Higher risk of fractures in the vertebrae
• Rarely, a neurological complication called cauda equina syndrome, which can cause problems with urinary retention, bowel control, and sexual function
• Decreased breathing capacity
• Inflammatory bowel disease (IBD) in up to 10% of people with AS
  

Remission

Generally, remission in ankylosing spondylitis and other chronic conditions refers to a stage in which there are no signs or symptoms of the disease. During this time, symptoms do not interfere with normal physical activity. However, these criteria are generalizations because there are no standardized criteria for remission in ankylosing spondylitis.

Ankylosing spondylitis is a lifelong disease that is always present in your body, even at the lowest levels of activity in remission. Though the disease remains present during periods of remission, it is often described as "background noise" because it remains, though at a level comparable to the symptoms in healthy people.

Remission is achievable in people with ankylosing spondylitis. It can occur spontaneously or as a result of drug therapy. Research indicates that drug-induced remission may be possible in people treated with non-steroidal anti-inflammatory drugs (NSAIDs) and up to two-thirds of those treated with TNF inhibitors.

Your rheumatologist will consider the following criteria in determining whether your ankylosing spondylitis is in remission:

• Physical examination for signs of tenderness, soreness, and stiffness
• Answers to subjective questions about your levels of pain and mobility, which are included on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the gold standard for evaluating disease activity
• Results of the Ankylosing Spondylitis Disease Activity Score (ASDAS), which includes a subjective assessment and blood tests that measure your levels of inflammation markers such as C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR)
• Magnetic resonance imaging (MRI) of your spine
  

Ankylosing Spondylitis Treatment

A comprehensive ankylosing spondylitis program includes a combination of medication, physical therapy/exercise, and healthy lifestyle options. Your treatment plan is individualized to your age, degree of disease activity, and other health conditions.

Working closely with your rheumatologist and other members of your healthcare team can help you get the best results from your treatment.

Medication

The following medications can treat ankylosing spondylitis:

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line drugs for ankylosing spondylitis treatment. They are effective for easing the pain and stiffness that is common with this disease. Over-the-counter versions of these drugs include:

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

Prescription NSAIDs include:

• Indocin (indomethacin)
• Mobic (meloxicam)
• Voltaren (diclofenac sodium)

Non-Biologic Disease-Modifying Antirheumatic Drugs (DMARDs)

Disease-modifying antirheumatic drugs (DMARDs) reduce symptoms and slow disease progression by changing the way your immune system works to decrease inflammation. These drugs treat inflammatory arthritis of the knee or hip that may be linked to ankylosing spondylitis. Conventional DMARDs include:

• Azulfidine (sulfasalazine)
• Rheumatrex (methotrexate)

Corticosteroids

Corticosteroids act on the immune system by blocking the production of inflammatory agents. This can relieve swelling and pain. Corticosteroids most often treat disease flares in ankylosing spondylitis. Commonly prescribed corticosteroids include:

• Cortisone 
• Hydrocortisone
• Methylprednisolone
• Prednisolone
• Prednisone

Tumor Necrosis Factor (TNF) Inhibitors

TNF inhibitors are biologics, a class of drugs created from living cells. Research shows that TNF inhibitors can also help people achieve drug-induced remission in ankylosing spondylitis. TNF inhibitors for treating ankylosing spondylitis include:

• Cimzia (certolizumab pegol)
• Enbrel (etanercept)
• Humira (adalimumab)
• Remicade (infliximab)
  
• Simponi (golimumab)

Interleukin (IL-17) Inhibitors

Interleukin (IL-17) inhibitors are biologics that target inflammatory proteins to reduce inflammation. These drugs include:

• Cosentyx (secukinumab)
• Taltz (ixekizumab)
  

Janus Kinase (JAK) Inhibitors

Janus kinase (JAK) inhibitors are the newest class of non-biologic DMARDs. These drugs interfere with the activity of one or more of the JAK enzymes that promote inflammation. The JAK inhibitors approved for AS are:

• Rinvoq (upadacitinib)
• Xeljanz (tofacitinib)

Therapy and Exercise

Symptoms and disease activity can worsen without regular movement. Physical therapy and exercise can help you remain mobile and flexible. Exercise works to increase general strength and flexibility.

Exercise can involve a wide range of activities, such as yoga, tai chi, stretching, or swimming, and provides the following benefits to people with ankylosing spondylitis:

• Improve posture
• Reduce pain and stiffness
• Counter fatigue
• Improve breathing capacity
• Advance your overall function

You may benefit from physical therapy. A physical therapy program is a focused and targeted set of movements and exercises designed to treat and prevent injuries and disabilities. For people with ankylosing spondylitis, these programs typically focus on improving or maintaining spinal and thoracic mobility.

Lifestyle Choices

Research indicates that a healthy lifestyle helps improve symptoms and reduce disease activity in ankylosing spondylitis and similar diseases.

In a 2022 study that examined how lifestyle factors affected people with spondyloarthritis, participants who had two or more unhealthy lifestyle factors had a higher risk of worse physical function, higher disease activity, worse pain and fatigue, and lower quality of life versus people with one or no unhealthy lifestyle factors.

In addition to following your treatment program, making the following lifestyle choices can reduce your risk of severe disease activity and flares:

• Establish and maintain a healthy weight.
• Consume a well-balanced, low-fat diet to help decrease inflammation.
• Increase your consumption of foods that are high in antioxidants, like fruits and vegetables.
• Participate in calming strategies like yoga or meditation to reduce stress.
  
• Limit alcohol consumption.
  
• Avoid highly processed foods and those with high amounts of salt, fat, and sugar.
• Don't smoke or use smokeless tobacco products.
• Get adequate good quality sleep.

Summary

Ankylosing spondylitis is a chronic disease that causes inflammation mainly in the joints of your spine. Without proper treatment, this damage can cause stiffness and pain, making it hard to move.

In advanced stages, this illness causes the vertebrae to fuse and limit movement. This level of damage can't be reversed or cured.

Early diagnosis and treatment can help reduce your risk of severe joint damage. Taking certain drugs, keeping active, and making healthy lifestyle choices can help you reduce your risk of severe disease effects.

The right treatment may also slow or stop the progress of the disease so you can achieve remission. This is a state in which there is no disease activity, even though the illness remains uncured. In this disease stage, symptoms don't cause problems in your daily life.