What Causes Ankylosing Spondylitis?
Although the cause of ankylosing spondylitis is unknown, there is a strong genetic or family link. Most, but not all, people with spondylitis carry a gene called HLA-B27. Although people carrying this gene are more likely to develop spondylitis, it is also found in up to 10% of people who have no signs of the condition.
How Is Ankylosing Spondylitis Diagnosed?
The diagnosis of ankylosing spondylitis is based on several factors, including:
- Findings of a physical exam
- X-rays of the back and pelvis
- Measurements of the chest when breathing
- Results of lab tests
How Is Ankylosing Spondylitis Treated?
There is no cure for ankylosing spondylitis, but there are treatments that can reduce discomfort and improve function. The goals of treatment are to reduce pain and stiffness, maintain a good posture, prevent deformity, and preserve the ability to perform normal activities. When properly treated, people with ankylosing spondylitis may lead fairly normal lives. Under ideal circumstances, a team approach to treat spondylitis is recommended. Members of the treatment team typically include the patient, doctor, physical therapist, and occupational therapist. In patients with severe deformities, osteotomy and fusion can be done.
- Physical and occupational therapy. Early intervention with physical and occupational therapy is important to maintain function and minimize deformity.
- Exercise. A program of daily exercise helps reduce stiffness, strengthen the muscles around the joints and prevent or minimize the risk of disability. Deep breathing exercises may help keep the chest cage flexible. Swimming is an excellent form of exercise for people with ankylosing spondylitis.
- Medications. Certain drugs help provide relief from pain and stiffness, and allow patients to perform their exercises with minimal discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen, naproxen, and aspirin — are the most commonly used drugs for spondylitis treatment. In moderate to severe cases, other drugs may be added to the treatment regimen. Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate(Rheumatrex), can be used when NSAIDs alone are not enough to reduce the inflammation, stiffness, and pain. In addition, relatively new drugs called biologics — adalimumab (Humira), adalimumab-atto (Amjevita), a biosimilar to Humira, certolizumab pegol (Cimzia), etanercept (Enbrel), etanercept-szzs (Erelzi), a biosimilar to Enbrel, golimumab (Simponi Aria, Simponi), infliximab (Remicade), and infliximab-dyyb (Inflectra), a biosimilar to Remicade, and secukinimab (Cosentyx)– have been FDA-approved for treating ankylosing spondylitis. Also, the antidepressant Cymbalta has been approved for chronic back pain as well. Steroid injections into the joint or tendon may be helpful in some cases.
- Surgery. Artificial joint replacement surgery may be a treatment option for some people with advanced joint disease affecting the hips or knees.