From the Guidelines
Robotic surgery is not a primary treatment option for ankylosing spondylitis (AS), and its use is generally limited to complex spinal procedures requiring precise screw placement in fused or deformed spines. The main goals of AS treatment are to reduce symptoms, maintain spinal flexibility and normal posture, reduce functional limitations, maintain work ability, and decrease disease complications, as outlined in the 2015 recommendations for the treatment of AS and nonradiographic axial spondyloarthritis 1. The primary treatment approach for AS includes nonsteroidal anti-inflammatory drugs (NSAIDs) and exercise, with the additional use of slow-acting antirheumatic drugs (SAARDs) in patients with peripheral arthritis, and biologic agents such as tumor necrosis factor inhibitors (TNFi) for patients who do not respond adequately to NSAIDs 1. Some key medications used in the treatment of AS include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen (500mg twice daily) or indomethacin (25mg 2-3 times daily)
- Biologic medications such as TNF inhibitors (adalimumab 40mg every other week, etanercept 50mg weekly, or infliximab 5mg/kg at weeks 0,2,6, then every 6-8 weeks) or IL-17 inhibitors (secukinumab 150mg weekly for 5 weeks, then monthly) Surgery, including robotic-assisted surgery, is typically reserved for severe cases with significant spinal deformity or joint damage, where the benefits of improved accuracy in navigating difficult anatomy may outweigh the risks 1. In these complex cases, robotic-assisted surgery may be used to improve accuracy in screw placement, potentially reducing complications in the challenging surgical environment created by the calcified ligaments and fused vertebrae characteristic of advanced AS. However, the use of robotics in AS treatment is not well-established, and conventional techniques remain the most common approach for surgical interventions. Overall, the treatment of AS should be individualized, taking into account the patient's specific clinical circumstances, values, and preferences, as well as the quality of evidence supporting different treatment options 1.
From the Research
Treatment Options for Ankylosing Spondylitis
- Non-pharmacological interventions, such as physical therapy exercises, have been shown to have positive effects on pain, disease activity, and physical function in patients with ankylosing spondylitis 2
- Non-steroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase (COX)-2-selective NSAIDs can be used for pain control in patients with ankylosing spondylitis 3
- Tumor necrosis factor alpha (TNF-α) inhibitors have been found to be effective in improving functional outcomes and decreasing disease activity in patients with ankylosing spondylitis 4, 5, 6
Efficacy of TNF-α Inhibitors
- TNF-α inhibitors have been shown to improve clinical symptoms, reduce inflammation, and prevent structural damage in patients with ankylosing spondylitis 5, 6
- The use of TNF-α inhibitors has been associated with a significant reduction in spinal inflammation and improvement in physical function 5
- The efficacy of TNF-α inhibitors in reducing disease activity and improving quality of life in patients with ankylosing spondylitis has been consistently demonstrated in multiple studies 4, 5, 6
Safety Profile of TNF-α Inhibitors
- The short-term toxicity profile of TNF-α inhibitors appears to be acceptable, with a low risk of serious adverse events 5
- However, regulatory agencies have published warnings about rare adverse events, including serious infections, malignancies, and lymphoma 5
- The long-term safety and efficacy of TNF-α inhibitors in patients with ankylosing spondylitis require further study 3, 4