While there is currently no cure for spondylitis, there are treatment options available to help ease the symptoms and limit progression of the disease.
Specific treatments for axSpA will be determined by your healthcare provider based on the specifics of your condition – such as the type of spondylitis and its severity – and factors such as your age, overall health, and medical history.
Types of treatments for spondylitis
Most treatments for axSpA fall into the categories of medication or surgery. Some people try lifestyle changes, clinical trials, and alternative pain relief techniques.
Some drugs prescribed for spondylitis can help reduce inflammation and disease activity and slow progressive damage, while others manage symptoms, but do not change the course of the disease.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are the first treatment most people try for spondylitis. Some NSAIDs such as Aspirin, Advil (Ibuprofen) and Aleve (Naproxen) are available over the counter, while Naprosyn (Naproxen), Indocin (Indomethacin), Celebrex (Celecoxib), and Voltaren (Diclofenac) require a prescription. NSAIDs are believed to work by inhibiting the production of chemicals that promote inflammation and blood clot formation in the body, reducing disease activity. Taken regularly at high doses, some NSAIDs can cause gastrointestinal problems and abnormal bleeding.
Biologic disease-modifying antirheumatic drugs (DMARDs)
Newer biologic drugs are designed to suppress specific aspects of the immune system responsible for inflammation in spondylitis. Biologics are usually taken long-term as maintenance drugs to improve symptoms and prevent disease progress. Remicade (Infliximab) and Simponi (Golimumab) are administered as intravenous infusions. Biologics including Humira (Adalimumab), Enbrel (Etanercept), Cosentyx (Secukinumab), Stelara (Ustekinumab), and Cimzia (Certolizumab pegol) can be self-administered as subcutaneous injections. Biologic drugs are generally indicated to be injected once every few weeks.
Since biologics suppress aspects of the immune system, many of these spondylitis treatments can increase your risk for contracting infections and, in rare cases, developing certain types of cancer. Each axSpA treatment has specific side effects and different levels of risk. Your doctor can help you understand the benefits and risks of each spondylitis medication based on your medical history and individual condition.
Drugs that prevent seizures in people with epilepsy can help reduce pain in some people with spondylitis. Anticonvulsants such as Lyrica (Pregabalin) and Gralise (Gabapentin) work by reducing pain signals sent by damaged nerves.
For pain that is not controlled with other treatments, some may require opioids such Ultram (Tramadol), Percocet (Oxycodone/Acetaminophen), and Vicodin (Hydrocodone/Acetaminophen). Opioids are believed to work on the brain by altering the body’s ability to perceive pain. According to the National Institute on Drug Abuse, regular use of opioids – even as prescribed by a doctor – can lead to dependence. If misused, opioids can cause overdose and death.
During disease flare-ups, doctors may prescribe corticosteroids such as Prednisone short-term. Steroids may be taken orally, intravenously, or injected directly into inflamed joints. Steroids cause serious side effects including weight gain, mood changes, and high blood glucose when taken long-term.
Depression and anxiety are common symptoms of spondylitis and other chronic diseases. Some people with axSpA take antidepressants to treat these symptoms. Some antidepressants such as Elavil (Amitriptyline) and Effexor (Venlafaxine) have been shown to help manage neuropathic (nerve-related) pain.
Surgery for spondylitis
Some people with spondylitis choose hip replacement if hip pain and dysfunction cannot be managed with medication. Hip replacement is a common type of arthroplasty, or joint replacement. Hip replacement is surgery to replace one or both hips with artificial joints made from plastic, ceramic, or metal components.
In advanced cases of ankylosing spondylitis, corrective spinal surgery may become necessary. A spine specialist may recommend surgery in cases where the spine has become deformed in a fixed flexed (forward) position that makes day-to-day activities difficult. Other criteria for surgery include spinal instability and neuropathy (nerve damage that causes weakness, pain, or tingling in the arms or legs).
Radiofrequency nerve ablation (RFA) is a technique used to provide long-term relief for some types of chronic pain. RFA is most often used to treat back pain including pain in the lumbar, cervical, and sacroiliac areas, plus the intervertebral discs, dorsal root ganglion, and sympathetic ganglia.
Is exercise good for people with spondylitis?
For people with all forms of spondylitis, exercise is one of the most important things you can do to treat your condition. Just a few minutes of gentle exercise each day can improve flexibility and mobility, preserve function, help you sleep better, and even help reduce pain. Exercise can make it easier to perform daily activities that spondylitis has made difficult. Read more about the benefits of exercise for people with axSpA.
Can diet help spondylitis?
Good nutrition can help people with spondylitis combat inflammation, reach and maintain a healthy weight, and avoid developing osteoporosis and other complications. In general, focus your diet on fresh vegetables and fruit, whole grains, legumes, fish, low-fat dairy products, and sources of healthy unsaturated fats such as nuts. Some people with axSpA feel better when they stick to the anti-inflammatory diet.
People with spondylitis need more of some nutrients than other people. Osteoporosis is a serious concern for people with spondylitis, who are at higher risk for losing bone mineral density even in early stages of the disease. Make sure to eat plenty of foods with calcium and vitamin D to fight osteoporosis. Foods rich in vitamin D include tuna, mackerel, salmon, egg yolks, and fortified products such as some milk, soy milk, orange juice, and cereal. Calcium is present in dairy, dark leafy greens such as kale and spinach, sardines, and fortified soy milk and orange juice.
Alcohol consumption can interact with some spondylitis medications and make others less effective, add unnecessary calories, and raise the risk for developing osteoporosis, gastrointestinal bleeding, and liver or kidney damage.
Read more about nutrition for people with spondylitis.
Physical therapy can help people with spondylitis reduce pain, preserve function, improve strength and balance, and stabilize joints. Physical therapy can also rehabilitate your body after surgery or injury. Physical therapy is widely recognized as a fundamental aspect of treatment for spondylitis.
Nerve block injections are useful to treat pain in people with spondylitis whose pain is not controlled by medications.
Is there a natural cure for spondylitis?
There is no cure for spondylitis at the present time. No natural, alternative treatments have been proven effective in clinical studies to delay disease progression. Some people with spondylitis find relief from certain axSpA symptoms by using complementary or alternative therapies such as medical marijuana, herbal supplements, chiropractic treatment, or acupuncture. Since some natural or holistic treatments can interfere with spondylitis medications or cause their own side effects, it is important to talk to your doctor before trying any alternative treatments.
What are the side effects of spondylitis treatments?
Any medication can cause side effects. Each spondylitis treatment has specific potential side effects associated with it. This does not mean that anyone who takes that axSpA medication will experience all, most, or any of the side effects it can potentially cause. Some side effects are very common, while some are extremely rare. Your doctor can help you assess the risks and benefits of each spondylitis treatment as they relate to your medical history and condition.
Which spondylitis treatments should I avoid?
Some spondylitis treatments carry a higher risk of causing serious side effects than others. For this reason, there are established guidelines for which axSpA treatments should be tried first, and which should be reserved for people who do not show improvement on the first-line treatments. However, with any medication, your risk of experiencing serious side effects depends on the details of your condition and personal and familial medical history. For instance, some spondylitis medications carry a higher risk for people with kidney or liver problems, heart disease, or increased rates of certain cancers in their family. With any disease-modifying spondylitis medication, the risk of serious side effects must be weighed against the benefit of clinically proven effectiveness in improving symptoms, preventing joint damage, and delaying the progression of the disease.
Can I get assistance paying for spondylitis medications?
Most people with private or employer-sponsored health insurance are eligible for copay assistance programs – many with a $0 copay – through the manufacturers of disease-modifying spondylitis treatments. Some people with low income and no health insurance may qualify for free axSpA medications through non-profit organizations or drug manufacturers. You can find more information about patient assistance programs here.