How is ankylosing spondylitis (AS) treated?
At this time there is no known curative treatment. Goals of treatment are to reduce pain and stiffness, slow progression of disease, prevent deformity, maintain posture and preserve function.
Exercise programs are an essential part of the treatment. Patients may be referred for a formal physical therapy program. Patients with AS are given daily exercises for stretching and strengthening, deep breathing exercises and posture exercises to avoid stooping and slumping.
Medications are also used to treat AS. Non-steroidal anti-inflammatory drugs (NSAIDs) are traditionally used to control symptoms. Steroids, such as cortisone or prednisone, are rarely used, except for with injections to a tendon or joint. Sometimes, medications that are normally used for rheumatoid arthritis, such as sulfasalazine or methotrexate, may be used. These appear to be less helpful for the spine disease. More recently, the biologic anti-TNF-a agents etanercept (Enbrel®), adalimumab (Humira®), and infliximab (Remicade®) have been approved for use in AS. These drugs may not only help symptoms but also slow the progression of the disease. They are only given as IV's in the doctor's office or by self-administered shots at home.
Surgical options are limited. There are no specific surgical interventions for the spine. Sometimes, in severe cases, replacement of the shoulder or hip joint is beneficial.
How is reactive arthritis treated?
At this time, there is no curative treatment. Any existing infection, if discovered, should be treated. The role of routine antibiotics is controversial. Physical therapy, stretching and exercise are prescribed. Non-steroidal anti-inflammatory drugs (NSAIDs) are given for pain and stiffness. Steroid injections to involved tendons or joints can help relieve pain and inflammation. In chronic or relapsing cases, similar treatments to rheumatoid arthritis can be considered to include methotrexate, sulfasalazine and the biologic anti-TNF-a drugs (as listed for AS).
How is enteropathic arthritis treated?
Like the other spondyloarthropathies, the patient needs physical therapy and exercise. Treatment of the bowel disease may help the peripheral joints but not the spine. Removing the colon (colectomy) in ulcerative colitis may "cure" the arthritis. One can use non-steroidal anti-inflammatory drugs (NSAIDs), but there is a need to be aware of the bowel effects. Local injection of steroids into joint(s) can be very helpful. Oral steroids can be used in more severe cases. In resistant cases, medications normally used to treat rheumatoid arthritis, such as methotrexate, azathioprine (Imuran®) or sulfasalazine can be tried for the joints. Anti-TNF-a drugs, like adalimumab (Humira®) and infliximab (Remicade®) have shown benefit with joint and bowel disease.