From the Guidelines
Ankylosing spondylitis (AS) typically presents with chronic low back pain and stiffness that improves with activity and worsens with rest, particularly noticeable in the morning or after periods of inactivity, as noted in the 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis 1. The symptoms of AS can be divided into several key areas, including:
- Chronic low back pain and stiffness
- Reduced spine flexibility
- Fatigue
- Pain that may radiate to the buttocks or backs of thighs
- Inflammation in the eyes (uveitis), causing redness and pain
- Enthesitis (inflammation where tendons and ligaments attach to bones), particularly in the heels
- Less commonly, inflammation in other joints like hips, shoulders, or knees
- Systemic symptoms such as mild fever, loss of appetite, and weight loss
- Respiratory issues may develop if the disease affects the chest and rib cage, limiting chest expansion, as discussed in the 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis 1. The goals of treatment for AS, as outlined in the 2019 update, are to alleviate symptoms, improve functioning, maintain the ability to work, decrease disease complications, and forestall skeletal damage as much as possible 1. It is essential to note that AS is an autoimmune condition that typically begins in early adulthood, with symptoms often developing gradually over months or years, and tends to affect men more severely than women, highlighting the need for early diagnosis and treatment to improve outcomes and quality of life 1.
From the Research
Ankylosing Spondylitis Symptoms
Ankylosing spondylitis (AS) is a type of arthritis that primarily affects the spine, although other joints can also be involved. The symptoms of AS can vary from person to person, but common symptoms include:
- Chronic back pain and stiffness
- Pain and stiffness in other joints, such as the hips, knees, and shoulders
- Fatigue
- Loss of mobility and flexibility in the spine
- Inflammation in the eyes, skin, and other parts of the body
Treatment Options
Treatment for AS typically involves a combination of non-pharmacological and pharmacological interventions. Non-pharmacological interventions include:
- Physical therapy and exercise to improve mobility and reduce stiffness 2, 3
- Education on disease management and lifestyle modifications 3 Pharmacological interventions include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation 2, 4, 5, 3
- Disease-modifying antirheumatic drugs (DMARDs) to slow disease progression 4, 5, 3
- Biologic agents, such as tumor necrosis factor-alpha (TNF-alpha) inhibitors, to reduce inflammation and slow disease progression 5, 6
- Targeted synthetic DMARDs, such as tofacitinib and upadacitinib, to reduce inflammation and slow disease progression 3
Efficacy of Treatment Options
The efficacy of these treatment options has been studied in various clinical trials. For example:
- A systematic literature review found that physical therapy and exercise had a moderate to high effect size on disease activity, function, and mobility in patients with AS 2, 3
- A review of pharmacological treatments found that NSAIDs and biologic agents were effective in reducing pain and inflammation in patients with AS 4, 5, 6
- A study on targeted synthetic DMARDs found that tofacitinib and upadacitinib were efficacious in reducing disease activity in patients with radiographic axSpA 3
Safety of Treatment Options
The safety of these treatment options has also been studied. For example:
- A review of biologic agents found that they were associated with an increased risk of adverse events, including serious infections and malignancies 6
- A study on targeted synthetic DMARDs found that they were generally well-tolerated, but may be associated with an increased risk of adverse events, such as infections and liver enzyme elevations 3