All patients should get physical or occupational therapy and do joint-directed exercises. Most recommended are exercises that promote spinal extension and mobility.
There are many drug treatment options. The first lines of treatment are the NSAIDs, such as naproxen, ibuprofen, meloxicam or indomethacin. No one NSAID is superior to another. Given in the correct dose and duration, these drugs give great relief for most patients.
For joint swelling that is localized (not widespread), injections, or shots, of corticosteroid medications into joints or tendon sheaths (the membrane around a tendon) can be effective quickly.
For patients who do not respond to the above lines of treatment, disease modifying antirheumatic drugs (commonly called DMARDs) such as sulfasalazine (Azulfidine) might be effective. These drugs relieve symptoms and may prevent damage to the joints. This class of drugs is helpful mainly in those with arthritis that also affects the joints of the arms and legs.
Although they may be effective, corticosteroids taken by mouth are not advised. This is because the high dose required will lead to many side effects.
Antibiotics are an option only for patients with reactive arthritis.
Some members of a newer class of drugs, known as biologics, are very effective in treating both the spinal and peripheral joint symptoms of spondyloarthritis. Biologics that the FDA has approved for use in patients with ankylosing spondylitis are:
TNF alpha blockers
- Infliximab (Remicade), which is given intravenously (by IV infusion) every 6-8 weeks at a dose of 5 mg/kg
- Etanercept (Enbrel), given by an injection of 50 mg under the skin once weekly
- Adalimumab (Humira), injected at a dose of 40 mg every other week under the skin
- Certolizumab (Cimzia), injected at a dose of 200 mg every other week or 400mg every 4 weeks under the skin
- Golimumab (Simponi), injected at a dose of 50 mg once a month under the skin
- Secukinumab (Cosentyx), injected at a dose of 150 mg every 4 weeks under the skin after a weekly loading dose for 5 weeks
However, biologic treatment may be expensive and not without side effects, including an increased risk for serious infections. Biologics can cause patients with latent tuberculosis (no symptoms) to develop an active infection. Therefore, you and your doctor should weigh the benefits and risks when considering treatment with biologics. Those with arthritis in the knees, ankles, elbows, wrists, hands and feet should try DMARD therapy before biologic treatment.
Surgical treatment is very helpful in some patients. Total hip replacement is very useful for those with hip pain and disability due to joint destruction from cartilage loss. Spinal surgery is rarely necessary, except for those with traumatic fractures (broken bones due to injury) or to correct excess flexion deformities of the neck, where the patient cannot straighten the neck.