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What can I do about AS?
If you have just been diagnosed with AS, don’t panic. Take a deep breath. Although you might have been diagnosed with AS, you are not alone. Luckily, there are effective treatments available. Even if they don’t cure AS, they can make living with the condition much more comfortable.
If you have AS or think you may have AS, your family doctor should refer you to a rheumatologist. A rheumatologist is a specialist doctor who is an expert in treating arthritis. This type of doctor is in the best position to help you manage your condition. Many people with inflammatory types of arthritis who see their rheumatologist regularly benefit from the highest level of care.
Here are some recommendations on what you should do:
- Learn as much as you can about this disease. Education is very powerful and we’ve aimed to develop this RheumInfo website to be accessible and easy to understand for everyday people living with AS and other forms of inflammatory arthritis
- Attend your rheumatologist appointments regularly
- Get your blood tests done as suggested by your rheumatologist
- Learn about the medications used to treat AS. The RheumInfo website has many interactive and valuable tools to help you understand these medications and their impact on your disease
Treatment of AS
People with AS can lead active and productive lives with the right kinds of treatment. There are a number of treatment options available, but a mixed approach is common. Whatever treatment approach you choose it is essential to remember two key points: treat AS early and treat it aggressively.
Why is it important to treat AS early?
The goal of treatment is to keep the spine flexible and the joints moving before AS causes bones to fuse together. Once the damage from AS is done it cannot be reversed with medicine. We want to stop AS before it damages your joints. We also want to get the joints back to moving smoothly as quickly as possible.
Here’s an analogy. In the movie The Wizard of Oz, one of the main characters was called the “Tin Man.” He needed to have his joints oiled all the time so he could keep moving. Without that, he would stiffen up and couldn’t move. People with AS are sometimes compared to the “Tin Man.” Instead of oil, people with AS need regular stretching and exercise to keep their joints moving smoothly. Many people also need medications to help control the inflammation and prevent it from damaging their joints.
Why is it important to treat AS aggressively?
Using the same “Tin Man” analogy, we want to keep the joints “oiled” and working smoothly. We don’t want just a little dab of oil here and there when a particular joint becomes stiff. We want to make sure all of the joints are working smoothly all of the time. We also need to make sure we have the right tools to do this. We don’t want to use any old oil that would do for a lawn mower. We want to use a high-grade, high-performance oil like the ones that are used in Formula-1 race cars.
It’s the same in AS: we want to get the joints back to moving smoothly as soon as possible so they won’t fuse together. The right treatment can reduce inflammation so that the joints don’t become damaged. This can help prevent stiffness, pain and loss of mobility.
Medications for AS
Medications for AS can help make living with the disease much more comfortable and help to improve function and mobility. Anti-inflammatory drugs such as NSAIDs and corticosteroids are groups of medications that can reduce inflammation, pain and stiffness. Other medications called analgesics can help reduce pain. Biologics are the most advanced and targeted medications for AS available so far. These medications are considered a major breakthrough in the treatment of AS.
For more detailed information about specific medications used to treat AS, refer to the Medications Section of RheumInfo.com.
Non-Steroidal Anti-Inflammatory Drugs or NSAIDs are medications that reduce the inflammation of joints caused by AS.
They also help to reduce symptoms such as pain. Luckily there are about 20 different anti-inflammatory medications available. So if one doesn’t work for you, try another.
Medications like prednisone can help control inflammation in some people. Usually, prednisone isn’t that effective for AS. However, in high doses for short periods of time it can be an effective medication to control the symptoms of AS. When used for long periods of time, prednisone can have side effects. You should to discuss the risks and benefits of using prednisone with your rheumatologist. Some patients also benefit from cortisone injections directly into a joint. This should be discussed with your rheumatologist.
Analgesic medications only control pain. They do nothing to control the disease or to prevent further joint damage. Analgesics can range from simple things like acetaminophen (Tylenol) to more potent narcotics like morphine.
The Disease Modifying Anti-Rheumatic Drugs (DMARDs) have been traditionally used to treat rheumatoid arthritis. They aren’t used as often in AS because they don’t work as well. As a general rule, DMARDs such as methotrexate or sulfasalazine don’t work to help symptoms in your back. However, they can be helpful for other swollen joints like the knees or hips.
Until about a decade ago, there were few other options for people with AS if anti-inflammatory medications weren’t enough to control their disease. That’s not the case today – people with AS whose pain and stiffness aren’t relieved by anti-inflammatory drugs can turn to a group of medications called anti-TNF biologics.
Anti-TNF biologics are extremely effective and can make a big difference for people with AS. There are now 5 anti-TNF biologics available including Humira, Remicade, Enbrel, Cimzia, and Simponi. With 5 different anti-TNF biologics to choose from, if one doesn’t work, your rheumatologist may suggest another.
Exercises for AS
Physical therapy has been shown to improve long-term outcomes for people with AS. It is therefore an important part of your overall treatment plan. The right stretching and exercises can actually improve the stiffness in your back, especially the kind that’s worse in the morning. Daily stretching and exercise can help improve posture and keep the joints in the back moving properly. It can also protect the joints by strengthening the muscles around them.
A trained arthritis physiotherapist can help design an exercise program tailored to you and your needs.
Below are some useful articles on exercising with arthritis:
- Exercise and Arthritis: An article by arthritis physiotherapist, Marlene Thompson
- Exercising in a Flare: Another excellent article written by Marlene Thompson on how to cope with flares through your exercise routine.
Natural or Home Remedies for AS
There are no known natural remedies or complementary therapies that have been proven to help AS in any significant way. However, it’s important to check with your rheumatologist to make sure that nothing interacts with your medication if you choose to use natural remedies or complementary therapies.
Surgery for AS
In the most severe cases of AS the joints of the spine and/or the pelvis are so badly damaged that they fuse together. When that happens, surgery may be necessary. Surgery usually involves replacing a damaged joint with an artificial joint, most commonly the hip. Surgery can help people with severe, advanced AS by reducing pain, improving their mobility and restoring their functioning. Surgery of the spine is more complex. This type of surgery is usually reserved only for people with severe deformity due to AS.
Diet for AS
Questions about diet and arthritis are very common. We all want to know what we can do to help ourselves. Can we change our diet to improve our immune system and help our arthritis? Changing our diet gives us a sense of control over a disease which often seems to have a mind of its own.
Unfortunately, there is no diet that has been proven to significantly alter the course of AS or other types of arthritis. Following the basics of healthy eating can help improve health and well-being in everyone, including those with AS. Keeping a healthy weight can help reduce the load on your weight-bearing joints including the spine and hips.
Alcohol and AS
Many of us like to share a glass of wine, a beer, or a spirit from time to time. Unfortunately, due to the nature of AS, some people may turn to alcohol to help cope with the pain and distress. Alcoholic beverages are not an effective treatment for AS. They can also interact with some medications.
Besides, there are so many effective treatments available for AS, you don’t need to try to manage your illness with alcohol.
Smoking and AS
Cigarette smoking, whether you have AS or not, has no positive effects on any aspect of your health. Smoking can be especially harmful to people with AS whose upper spine is affected by the disease. That’s because when the upper spine is inflamed and the bones begin to fuse together, it’s harder to breathe in deeply. If you are a smoker with AS, quitting could be one of the best things you can do to improve your overall health.