What treatments help manage ankylosing spondylitis at 44?

Question

Hello doctor,

I am reaching out to my cousin. He is 44 and was recently diagnosed with something called ankylosing spondylitis. None of us had even heard of it before, and he struggles to wrap his head around what this means for his life.

He has always been pretty active, but lately, his back pain has gotten so bad that he is having a hard time getting up in the mornings, and it is even affecting his job.

He has been on some pain medications, but they do not seem to last long, and he is honestly getting frustrated. He is worried this condition might mean he will eventually be unable to move or might even end up with a hunched back. He has tried a few stretching exercises as well here and there, but nothing seems to be making a real difference.

Is there any other treatment that could help him out here?
Should he be looking into physical therapy or something more specific?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Ankylosing spondylitis (a type of arthritis that causes inflammation in the joints and ligaments of the spine) can indeed be a challenging diagnosis, especially for someone as active as he is. AS is a type of arthritis that primarily affects the spine and sacroiliac joints (where the spine meets the pelvis), causing pain, stiffness, and inflammation.

Over time, it can lead to the fusion of the vertebrae, potentially resulting in a more hunched posture if untreated. However, there are several treatment and lifestyle strategies that could help him manage the pain, maintain mobility, and preserve his quality of life.

Since your cousin has only tried pain medications with limited success, he might benefit from other medication options specifically targeting AS:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first line of treatment in AS because they help reduce both pain and inflammation. If over-the-counter NSAIDs are not sufficient, his doctor might consider a stronger prescription.
Biologic therapies: If NSAIDs do not bring enough relief, biologics such as TNF inhibitors, e.g., Humira, Enbrel, or IL-17 inhibitors, e.g., Cosentyx, are often used. These drugs target specific pathways in the immune system to reduce inflammation and help prevent structural damage in the spine. Biologics can be a game-changer for many AS patients, significantly reducing pain and stiffness and improving mobility.
JAK inhibitors (Janus kinase inhibitors) are newer class of medications targets inflammatory pathways differently from biologics and has shown promise in treating AS for patients who do not respond well to other options.

Physical therapy can be very effective for managing AS, especially when it is tailored to the patient's specific needs. A physical therapist experienced in AS can guide him through exercises to:

Improve posture, which is critical for preventing or delaying spinal fusion.
Increase flexibility and maintain the spine’s range of motion.
Strengthen core muscles, which can help support the spine and alleviate pain.
Regular sessions with a physical therapist, along with a consistent at-home exercise routine, are key components of long-term AS management.
Certain stretching exercises, like yoga or pilates, can also help reduce stiffness and improve mobility.

Lifestyle adjustments and activity management:

Staying active is important for people with AS, but it is essential to balance movement with rest. Some helpful strategies include:
- Swimming, walking, and cycling can keep his joints moving without placing too much strain on them. Water-based exercises are especially beneficial, as water supports the body and allows for greater movement with less impact.
- Developing a habit of gentle stretching first thing in the morning can help reduce stiffness and pain. Many AS patients find relief from specific back stretches, like lying flat on the floor and slowly pulling knees to the chest.
- Maintaining good posture throughout the day can prevent or reduce stiffness. Your cousin might want to look into ergonomic adjustments for his work environment, such as a supportive chair and monitor at eye level to encourage upright posture.
- Applying heat to the affected areas, such as using a heating pad in the morning, can loosen stiff muscles and relieve pain. A warm shower can also provide relief, especially before starting the day or before stretching.
Stress and emotional tension can often exacerbate pain and stiffness. Practicing relaxation techniques like deep breathing, meditation, or mindfulness can help him better cope with the discomfort and stress of living with AS.
A checkup with a rheumatologist (specialist in inflammatory diseases) is essential for AS management. A rheumatologist can monitor your cousin's condition, recommend specific therapies, and adjust his treatment plan as needed. Since AS is a progressive condition, early intervention with appropriate medications and therapies is key to slowing disease progression.
Learning more about AS and connecting with others who have the condition may help him feel less isolated and more informed about his options. Support groups, either in person or online, can provide valuable insights and encouragement.

While AS is a lifelong condition, with the right combination of treatments and lifestyle adjustments, your cousin can still lead an active and fulfilling life. The goal is to find the right mix of therapies, exercises, and habits that work best for him. With proper management, many people with AS successfully keep their symptoms under control and prevent severe complications.

I hope this information will help you.

Kindly revert in case of queries.

Thank you.