Can people with ankylosing spondylitis (axSpA) lead normal lives?

Can People with Axial Spondyloarthritis Lead Normal Lives?

While patients with axSpA have a reduced quality of life compared to the general population, modern treatment strategies aim to maximize long-term health-related quality of life through control of symptoms and inflammation, with the goal of preserving or normalizing function and social participation. 1

The Reality of Living with AxSpA

Disease Impact on Quality of Life

• Studies clearly demonstrate that patients with axSpA have reduced quality of life compared to non-diseased populations. 1
• AxSpA is recognized as a potentially severe disease with diverse manifestations that can importantly interfere with patients' daily living. 1
• Approximately 40% of patients experience at least one extra-articular manifestation (such as uveitis, psoriasis, or inflammatory bowel disease) during the course of disease, which further impacts quality of life. 1
• The disease incurs high individual, medical, and societal costs that affect overall life functioning. 1

Achievable Treatment Goals

The primary treatment goal is to maximize health-related quality of life through symptom control, prevention of structural damage, and preservation/normalization of function and social participation. 1

• While remission is the preferred therapeutic target, most patients with axSpA will achieve only sustained low disease activity during long-term treatment, which should be considered an acceptable alternative target. 1
• With optimal management combining non-pharmacological and pharmacological treatments, patients can achieve significant improvements in function and participation. 1

Treatment Approach to Optimize Quality of Life

First-Line Management

• NSAIDs are the treatment of choice for the majority of patients with axSpA, as they are highly effective against pain and stiffness and may have disease-modifying properties. 2
• Patients should be educated about axSpA and encouraged to exercise regularly, with physical therapy strongly recommended during all stages of disease. 1
• Active physical therapy and supervised exercise is strongly recommended over passive approaches. 1

Advanced Therapies When Needed

• Biologic DMARDs (TNF inhibitors or IL-17 inhibitors) should be considered in patients with persistently high disease activity despite conventional treatments. 1, 3
• These advanced therapies have transformed axSpA from a largely untreatable disease to one where significant symptom control and functional improvement are achievable. 3

Critical Caveats

Diagnostic Delays Worsen Outcomes

• The estimated diagnostic delay for axSpA is 14 years in the USA, which significantly impacts long-term outcomes and quality of life. 4
• Delayed or inadequate treatment may lead to irreversible loss of spinal function and decreased quality of life. 4
• Only 37% of patients with ankylosing spondylitis in the USA are diagnosed by rheumatologists, with the majority diagnosed in non-rheumatology settings where treatment may be suboptimal. 4

The Importance of Multidisciplinary Care

• AxSpA usually requires multidisciplinary management coordinated by a rheumatologist who serves as the central coordinator in a network of specialists. 1
• Treatment must combine pharmacological and non-pharmacological modalities to achieve optimal outcomes. 1

Bottom Line

Most people with axSpA do not live completely "normal" lives in the sense of having quality of life equivalent to the general population, but with early diagnosis, appropriate treatment, and comprehensive management, they can achieve preservation or normalization of function and social participation. 1 The key determinants of outcome are early diagnosis (avoiding the typical 14-year delay), prompt referral to rheumatology, and aggressive treatment targeting remission or low disease activity. 4, 5