Treating ankylosing spondylitis Part 1

There is no cure for ankylosing spondylitis (AS). Treatment aims to relieve symptoms and slow the process of the spine stiffening.

Physiotherapy

Keeping active can improve your posture and your range of spinal movement, as well as preventing your spine from becoming stiff and painful.

As well as keeping active, physiotherapy is a key part of treating ankylosing spondylitis. A physiotherapist (a healthcare professional  trained in using physical methods of treatment) can advise about the most effective exercises and draw up an exercise programme suitable for you.

Types of physiotherapy recommended for ankylosing spondylitis include:

• Group exercise programme, where you exercise with others
• An individual exercise programme – you are given exercises to do by yourself
• Massage – your muscles and other soft tissues are manipulated to relieve pain and improve movement (the bones of the spine should never be manipulated as this can cause injury in people with ankylosing spondylitis)
• Hydrotherapy – exercise in water (usually a warm, shallow swimming pool or a special hydrotherapy bath); the weight of the water helps improve your circulation (blood flow), relieve pain and relax your muscles
• Electrotherapy – electric currents or impulses (small electric shocks) make your muscles contract (tighten), which can help ease pain and promote healing

Some people prefer to swim or play sport to keep flexible. This is usually fine, although some daily stretching and exercise is also important (see below).

Exercise

The National Ankylosing Spondylitis Society (NASS) provides detailed information about different types of exercise to help you manage your condition.

However, if you are in doubt, speak to your physiotherapist or rheumatologist before taking up a new form of exercise or sport.

Alongside physiotherapy, you will also probably be prescribed medication, such as:

• Painkillers
• Tumour necrosis factor (TNF) blockers
• Bisphosphonates
• Disease-modifying anti-rheumatic drugs (DMARDs)
• Corticosteroids

These are described below.

Painkillers

You may need painkillers to manage your condition while you are being referred to a rheumatologist. The rheumatologist may continue prescribing painkillers, although not everyone needs them, at least not all the time. The first type of painkiller usually prescribed is a non-steroidal anti-inflammatory drug (NSAID).

Non-steroidal anti-inflammatory drugs (NSAIDs)

As well as helping to ease pain, non-steroidal anti-inflammatory drugs (NSAIDs) help relieve inflammation (swelling) in your joints. Examples of NSAIDs include:

• ibuprofen
• naproxen
• diclofenac

When prescribing NSAIDs, your GP or rheumatologist will try to find the one that suits you best and the lowest possible dose that relieves your symptoms. Your dose will be monitored and reviewed as necessary.

Paracetamol

If NSAIDs are unsuitable for you, an alternative painkiller, such as paracetamol, may be recommended.

Paracetamol rarely causes side effects and can be used in women who are pregnant or breastfeeding. However, paracetamol may not be suitable for people with liver problems or those dependent on alcohol (have an alcohol addiction).

Codeine

If necessary, as well as paracetamol, you may also be prescribed a stronger type of painkiller called codeine. Codeine can cause side effects including:

• Nausea (feeling sick)
• Vomiting (being sick)
• Constipation (an inability to empty your bowels)
• Drowsiness, which could affect your ability to drive

Treating ankylosing spondylitis Part 2- click HERE