Treating or not treating

WHY IS EARLY TREATMENT FOR AS SO IMPORTANT?

Patient

AS causes inflammation in the spine and sometimes other joints (often hips and shoulders). This inflammation usually results in stiffness of the spine and other joints.

- The Arthritis Society of Canada

Treatment of AS

With the guidance of your doctor and other healthcare professionals, you can manage your AS.

  • Heat and cold to reduce pain and stiffness
  • You can take action to protect your joints. Physiotherapy and/or occupational therapy can help.
  • Medications can help to reduce inflammation in your joints in order to relieve pain and help slow joint damage.
  • Surgery may be an option for severely damaged joints.

NON-PHARMACOLOGICAL TREATMENTS

Heat (warm shower or warm pack) can help:

  • Relieve pain
  • Relieve muscle spasms and tightness
  • Increase range of motion

Use a protective barrier, such as a towel, between the warm pack and the skin.

To avoid making symptoms worse, heat should not be applied to an already inflamed joint.

Cold (cold pack or crushed ice, ice cubes, or a bag of frozen vegetables) can help:

  • Decrease swelling
  • Decrease pain
  • Reduce blood flow to an inflamed joint

Use a protective barrier, such as a towel, between the cold pack and the skin.

You can use your joints in a way that reduces the stress placed on them. 

By protecting your joints, you may:

  • Experience less AS pain
  • Perform tasks more easily
  • Help prevent further damage

Examples of how you can protect your joints:

  • Pace yourself throughout the day – alternate heavy tasks with lighter tasks and take breaks.
  • Position your joints to minimize stress (e.g., when carrying heavy items, keep them at waist height).
  • Talk to your doctor or other healthcare professional about splints, braces, or shoe inserts to help support your joints.

Consider assistive devices such as a cane and jar openers.

About a third of people with AS will develop eye inflammation.

This is a rapid onset of inflammation in the front of the eyeball. The eye may feel irritated and there may be pain in the eye or surrounding area. You could experience headaches, blurred vision, or sensitivity to light. It usually happens in one eye only.

If you think you may have eye inflammation, you should be referred to an ophthalmologist (eye specialist). Prescription eye drops may halt the attack and prevent potential loss of vision.

AS patients may develop a fused spine. Often, the fused spine becomes brittle and can fracture easily.

  • Generally, people with AS should take calcium and vitamin D supplements (ask your doctor if these supplements are appropriate for you).
  • Activities involving forward bending or heavy lifting should be avoided.
Did you know?
When recommended by their doctor, people with AS should take calcium and vitamin D supplements to help reduce the risk of fracture.

PHARMACOLOGICAL TREATMENTS

The following medications may be used to treat AS:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) – most commonly used to treat the pain and inflammation of AS
  • Corticosteroids (steroids) may be used to try and control symptoms during flares of AS.
  • Biologics are used to suppress inflammation.

NSAIDs are a type of medication used to treat the pain and inflammation of arthritis.

NSAIDs:

  • Can be taken on an as-needed basis and do not need to be taken regularly.

Some patients may find it helpful to take their NSAID on a regular basis to control their symptoms.

Results from recent studies have suggested that NSAIDs may help to prevent spinal damage in AS.

NSAIDs are available over the counter and by prescription. Talk to your doctor about NSAID treatment.

SIDE EFFECTS ASSOCIATED WITH NSAIDs:
Risk of GI side effects and thrombotic events; people with heart disease, or a history of stroke, or serious chest pain should not take NSAIDs.

Cortisone (a steroid naturally present in our bodies):

  • Is a hormone produced naturally by the body’s adrenal glands.
  • Regulates routine inflammation from minor injuries and major traumas, such as broken bones or surgery.

The adrenal gland cannot produce enough cortisone naturally to regulate AS.

In AS, steroids are generally used for short durations to quickly relieve a flare of symptoms or to get a newly diagnosed disease under control. Steroids work quickly (usually within a few days) and some patients may even start to feel better within hours of taking the first dose.

SIDE EFFECTS ASSOCIATED WITH CORTICOSTEROIDS:
Osteoporosis, hypertension, weight gain, fluid retention, hyperglycemia, cataracts, skin fragility, and possibly premature atherosclerosis

Biologics are a type of medication used to treat inflammatory types of arthritis.

Biologics:
Different types of biologics vary in the way they work in the body

  • Biologics are used to suppress inflammation in the joints.
  • Can take some time to work. 

SIDE EFFECTS ASSOCIATED WITH BIOLOGICS:
Infusion or injection site reactions, and increased risk of serious infections, tuberculosis, and lymphoma

Surgery

People with severe, advanced AS may require surgery for badly damaged joints. 

Surgery usually involves replacing a joint with an artificial joint, e.g., a total hip joint replacement. 

After surgery, patients may have less pain, better movement and restored function. 

SIDE EFFECTS ASSOCIATED WITH SURGERY:
Vary depending on the procedure.