How is Axial Spondyloarthritis Treated?

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 maximize quality of life, prevent or slow progressive structural damage, and control symptoms and inflammation and preserve mobility.1

Treating axial spondyloarthritis is individualized

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 comorbid conditions you might have, and whether your disease is active or stable. Think of your treatment plan as a dynamic thing; it can change – and should change – based on your response to treatment and how it’s working for you.

Various parts of a treatment plan can include exercise and/or physical therapy, medications, lifestyle changes, or surgery, among other components. Talking with your doctor on a regular basis about your symptoms, how your AxSpA is affecting your quality of life, how your treatment is working, and any changes you’ve noticed can help them create a treatment plan with you that will be personalized for your needs.

Exercise and physical therapy

Exercise is important for people living with an AxSpA spectrum condition. Exercise helps increase and maintain flexibility and range of motion, helps to improve posture, and can reduce stiffness and pain.2 It can also improve sleep, help with balance, and promote cardiovascular health.2

Physical therapy has been found to benefit those living with AxSpA spectrum conditions, especially because people are shown how to do exercises correctly in a way that will not injure them.3 Education, along with physical therapy, is beneficial. When combined with medication, physical therapy has been especially effective in reducing symptoms and promoting mobility, when compared to medication treatment alone.3

Medications

There are a variety of medications used to help treat AxSpA conditions. Medications in your treatment plan can change over time if they become less effective, stop controlling symptoms, if your symptoms change at all, or if you don’t respond well to a drug.

The first-line of medications tried are usually the nonsteroidal anti-inflammatory drugs (NSAIDs).4 These are often used alongside exercise and/or physical therapy, and can include naproxen or indomethacin.4 These drugs help reduce inflammation and ease pain. Pain relievers like acetaminophen may also be used if you can’t take NSAIDs, but they won’t reduce inflammation.

Other drugs that can be helpful in treating AxSpA spectrum conditions include disease modifying anti-rheumatic drugs (DMARDs), biologics like tumor necrosis factor (TNF) inhibitors, and anti-interleukin 17 therapy.5,6 DMARDs help relieve symptoms and may help prevent damage to joints.5 Biologics can help target inflammation but can be expensive and have significant side effects. Your doctor can go over all of the possible medication options with you, and talk with you about which ones may be best for you at any given moment.

Lifestyle changes

Along with exercise, some people find that making changes to their lifestyle help promote health and reduce symptoms. Lifestyle changes can also help address any comorbid conditions you have as well. Changes can include stopping smoking cigarettes, reducing alcohol intake, and making changes to home décor to reduce the risk of falls and fractures.

Surgery

In some people with AxSpA spectrum conditions, hip or spine surgery may be helpful. Surgery may include a total hip replacement (also called arthroplasty), spinal surgery like fusion, or a wedge osteotomy, which is when a wedge-shaped piece of bone is removed from the spine and then the spine is realigned.6

If you have questions or concerns about your AxSpA spectrum treatment, talk with your doctor. Treatment plans can be changed if they’re not effective, and you’ll be able 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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Written by: Jaime Rochelle Herndon | Last reviewed: November 2020