How is Axial Spondyloarthritis Treated?

Reviewed by: HU Medical Review Board | Last reviewed: May 2022 | Last updated: June 2022

While axial spondyloarthritis (AxSpA) is a chronic, progressive condition, there are treatments. There is no cure, but there are treatments in order to help manage the condition. Rather than cure, the goals of treatment are to:1

  • Maximize quality of life
  • Prevent or slow progressive structural damage
  • Control symptoms and inflammation
  • Preserve mobility

Treating axial spondyloarthritis is customized for each person

The treatment plan can vary depending on where your disease activity is on the AxSpA spectrum. It also varies depending on:

  • Your symptoms
  • Your overall health
  • Any other conditions you may have
  • Whether your disease is active or stable

Think of your treatment plan as a dynamic thing. It can – and should – change based on your response to treatment and how it is working for you.

Your treatment plan may include:

  • Exercise and/or physical therapy
  • Medicines
  • Lifestyle changes
  • Surgery

Talk with your doctor on a regular basis about your symptoms. You should discuss how your AxSpA is affecting your quality of life, how your treatment is working, and any changes you have noticed. This can help you and your doctor create a customized treatment plan that meets your needs.

Exercise and physical therapy

Exercise is important for people living with an AxSpA spectrum condition. Exercise can:2

  • Reduce stiffness and pain
  • Increase and maintain flexibility and range of motion
  • Improve posture
  • Improve sleep
  • Help with balance
  • Promote heart health

Physical therapy has been proven to help those living with AxSpA spectrum conditions. It is especially helpful because people are shown how to do exercises in a way that will not injure them. When combined with medicine, physical therapy can be very effective in reducing symptoms and promoting mobility compared to drug treatment alone.3


There are many medicines used to help treat AxSpA conditions. Medicines in your treatment plan can change over time if:

  • They become less effective
  • They stop controlling symptoms
  • Your symptoms change
  • You do not respond well to a drug

The first medicines tried are usually nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or indomethacin. They are often used along with exercise and/or physical therapy. These drugs help reduce inflammation and ease pain. Pain relievers like acetaminophen may also be used if you cannot take NSAIDs. However, they do not reduce inflammation.4

Other drugs that can be helpful in treating AxSpA spectrum conditions include:5,6

  • Disease modifying anti-rheumatic drugs (DMARDs), which help relieve symptoms and may help prevent damage to joints.
  • Biologics like tumor necrosis factor (TNF) inhibitors, which can help target inflammation. However, they may be expensive and have serious side effects.
  • Biologics like anti-interleukin 17 therapy

Your doctor can discuss possible medicine options with you and talk about which ones may be right for you.

Lifestyle changes

Along with exercise, some people find that making changes to their lifestyle helps promote health and reduce symptoms. Lifestyle changes may also help address any other conditions you have. Changes can include:

  • Stopping smoking cigarettes
  • Reducing alcohol intake
  • Making changes in your home to reduce the risk of falls and fractures


In some people with AxSpA spectrum conditions, hip or spine surgery may be helpful. Surgery may include:6

  • Total hip replacement (arthroplasty)
  • Spinal surgery like fusion
  • Wedge osteotomy, which is when a wedge-shaped piece of bone is removed from the spine and then the spine is realigned

If you have questions or concerns about your AxSpA spectrum treatment, talk with your doctor. Treatment plans can be changed if they are not effective. You can also work with your doctor to learn about the reasons behind the treatments chosen and share your concerns about them. Together, you can work with your doctor to find the best treatment plan for you.

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