What are the treatment options for ankylosing spondylitis (AS) and undifferentiated spondyloarthropathy (USpA)?

Updated: Feb 02, 2021
  • Author: Lawrence H Brent, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

No definite disease-modifying treatment exists for individuals with ankylosing spondylitis (AS) although biologic agents show evidence of such activity. Early diagnosis is important. As with any chronic disease, patient education is vital to familiarize the patient with the symptoms, course, and treatment of the disease. Treatment measures include pharmacologic, surgical, and physical therapy.

No drugs have been proved to modify the course of the disease, although tumor necrosis factor-α (TNF-α) inhibitors (TNHi) and IL-17 inhibitors (IL-17i) appear to have potential as disease-modifying agents. [99] Symptoms are generally not affected by pregnancy or childbirth. Medical management of AS, including medications, must be adjusted during pregnancy in accordance with the specific pregnancy profiles of the medications.

Inpatient care is generally not necessary for patients with AS. The exceptions to this include patients with coexisting or extra-articular disease and those requiring surgery.

Extra-articular manifestations, which may necessitate specialist referral for appropriate care, include the following:

  • Acute anterior uveitis
  • Aortitis
  • Conduction defects
  • Pulmonary fibrosis
  • Amyloidosis
  • Neurologic deficits, including cauda equina
  • Associated inflammatory bowel disease

Disease progress and response to therapy can be monitored by following laboratory values, including the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level.

Surgical treatment is geared toward resolution of the complications related to AS; it is occasionally used for repairing damaged peripheral joints and rarely used to correct spinal deformities as it involves significant morbidity. Patients with fusion of the spine secondary to AS who report a change in position of the spine should be treated cautiously and should be considered to have sustained a spinal fracture. Surgical intervention may be necessary to stabilize the fracture and prevent neurologic deficit. [100, 101]

Outpatient care should be aimed toward providing adequate pain control and maximizing motion and functional ability. Such care includes pain medication, exercise programs, recreational therapy, and vocational therapy. Regular exercise helps reduce the symptoms and may slow the progress of the disease. Generally, no dietary restrictions are implemented for patients with AS; however, patients with coexisting diseases, such as inflammatory bowel disease (IBD), have dietary restrictions.


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