Treatment options for ankylosing spondylitis 

Treatment
Pros
Cons
Physiotherapy

A physiotherapist can give you advice about suitable exercises and activities to help you stay flexible and reduce pain

  • Improves your flexibility and range of spinal movement to reduce stiffness and pain
  • Improves your posture, which may help to reduce any feelings of self-consciousness
  • Wide range of exercises available to create a personal programme
  • Pain and stiffness may return if you stop exercising
  • Often still need to take some form of medication

Painkillers

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen, are often prescribed to help manage pain and swelling (inflammation) in the joints

  • May help to reduce pain and inflammation 
  • Usually start to work very quickly  with a rapid improvement in symptoms often seen within 48 hours
  • Not suitable for people with a history of kidney, liver or stomach problems
  • Not suitable if pregnant or breastfeeding
  • Side effects are uncommon, but can include nausea, vomiting and stomach ulcers
Paracetamol

Paracetamol is a painkiller that may be used if NSAIDs are unsuitable for you

  • May help to reduce pain
  • Can be used in women who are pregnant or breastfeeding
  • Rarely causes side effects
  • Not suitable for people with kidney or liver problems
  • Not suitable for people are alcohol dependent
Codeine

Codeine is a stronger painkiller that may be prescribed alongside paracetamol

  • May help to reduce severe pain
  • Not suitable for everyone
  • Can’t be taken for too long as you may become dependent on them 
  • Side effects can include nausea, constipation and drowsiness

Other medications

Anti-TNF medication

Anti-TNF (tumour necrosis factor) medications are a relatively new treatment. They are given by injection to reduce pain and inflammation in the joints

  • May help to reduce pain and inflammation
  • May help significantly reduce disability in the short and long term
  • Not suitable for everyone
  • Long-term effects are not yet fully known
  • Injections may be needed every other week
  • Assessment needed every 12 weeks
  • Side effects include a lowered immune system, which could lead to potentially serious infections
Disease-modifying anti-rheumatic drugs (DMARDs)

DMARDs are usually used to treat other types of arthritis, but may be effective at reducing symptoms of ankylosing spondylitis affecting areas other than the spine (peripheral joints)

  • May help to reduce pain and inflammation in peripheral joints 
  • Not suitable for everyone
  • No evidence of benefit for pain and inflammation affecting the spine
  • May need to be taken for several weeks before noticeable improvement
  • Common side effects include nausea, stomach pain, diarrhoea and headaches
Corticosteroids

Corticosteroids have a powerful anti-inflammatory effect and may be used to treat moderate to severe symptoms of ankylosing spondylitis

  • May help to reduce symptoms of pain and inflammation
  • Injection can be used to target specific joints
  • Can be taken as tablets when pain is less severe
  • Not suitable for everyone
  • Need to rest the joint for 48 hours after an injection
  • May only be used a few times a year to avoid side effects
  • Side effects may include infection, the skin around the injection changing colour, tissue wasting away or a ruptured tendon