Treatment of Ankylosing Spondylitis

Treatment of

Ankylosing Spondylitis (AS)

Physiotherapy is a key element of treatment and physiotherapy has beneficial effects for patients with Ankylosing Spondylitis (AS).

Exercises should include deep breathing and aerobic exercise, stretching, strengthening, and postural exercises, spinal extension and a range of motion exercises for the spine. Swimming and pilates are also recommended. Spinal surgery may be of value in selected patients and is performed for a variety of reasons in ankylosing spondylitis patients.<sup>1</sup>

Best Exercises for Ankylosing Spondylitis (AS)

Pilates

Pilates

Extension exercises

Spinal extension exercises

Postural exercises

Postural exercises

Deep breathing

Deep breathing

Yoga

Yoga

Motion Exercises

Motion exercises

Aerobics

Aerobics

Stretching

Stretching

Treatment types for Ankylosing Spondylitis (AS)

Lifestyle Changes

Lifestyle changes

Physical Therapy

Physical therapy

OTC Therapies

Over-the-counter therapies

Prescription medication

Alternative medicine

 Alternative medicine like yoga or acupuncture

Surgery

Surgery

Among the drug therapies, the following options are available<sup>2,3</sup>

Slide 1
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) - NSAIDs improve spinal pain, peripheral joint pain, and function in ankylosing spondylitis. Chronic use of NSAIDs may, however, increase CV risk.

Slide 2
Disease-modifying antirheumatic drugs (DMARDs) - The main DMARDs are sulfasalazine and methotrexate. However, neither of these drugs nor other DMARDs seem to have any benefit in ankylosing spondylitis.

Slide 3
Bisphosphonates - Oral bisphosphonates are commonly used for fracture prevention in ankylosing spondylitis.

Slide 4
Tumour necrosis factor inhibitors (Biologics) - Drugs that inhibit tumour necrosis factor (TNF) are widely used in ankylosing spondylitis. They treat ankylosing spondylitis for spinal pain, function, and peripheral joint disease.

Slide 5
Biosimilars - A biosimilar is a medicine that is highly similar to another biological medicine that has already been authorized for use due to proven efficacy. The biosimilars etanercept, adalimumab, and infliximab are as efficacious as the biologics and also cost-effective.

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Biosimilar medicines are structurally not exact copies of the original biologic drug and hence, are not generics. The idea of developing a biosimilar was to provide alternative products, with similar efficacy, at a lower cost than the original biological medicines (like etanercept, infliximab, and adalimumab).  Biosimilars have comparable quality, safety, and effectiveness to biologicals from which they have been derived. The amino acid sequence, potency, dosing, route of administration and clinical effects are identical in both biosimilars and biologicals.

Biosimilars

References –

  1. Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2018 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470173/
  2. Research findings: exercise for ankylosing spondylitis. Frontline 2 January 2019. https://www.csp.org.uk/frontline/article/research-findings-exercise-ankylosing-spondylitis. Accessed 17 Dec 2019