Treatment for Axial Spondyloarthritis

Reviewed by: HU Medical Review Board | Last reviewed: January 2023

Axial spondyloarthritis (axSpA) is a type of inflammatory arthritis that affects the spine and may affect other joints. There is currently no cure for axSpA, and treatment is different for each person. This is because axSpA affects people in different ways.1

The main goals for axSpA treatment are to:1

  • Manage pain and stiffness
  • Reduce inflammation
  • Improve physical function
  • Slow the progression of the disease

Types of treatment for axSpA

Treatment for axSpA usually combines certain lifestyle changes and medicines. For some people, it may include surgery. Some include complementary treatment options in their treatment plan as well.2

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Lifestyle changes

Many people with axSpA need to change their lifestyle to help them manage their condition. Lifestyle changes may take several forms, such as:2-6

  • Quitting smoking – Smoking has been linked to an increased risk of axSpA and other diseases.
  • Staying active – Exercise strengthens muscles, improves joint flexibility, and can help with pain management.
  • Staying hydrated – Drinking enough water helps keep your joints lubricated. This can reduce inflammation and stiffness.
  • Making healthy food choices – Eating a balanced diet can help manage pain and improve overall health.
  • Managing stress – Stress can worsen axSpA symptoms. So, it is important to find ways to relax and manage stress.
  • Getting enough sleep – Getting plenty of restful sleep is essential for managing pain and fatigue.


Medicine options for axSpA treatment include:2,3

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), which help relieve pain and inflammation
  • Disease-modifying antirheumatic drugs (DMARDs), which help slow the progression of axSpA by blocking substances in your body that cause inflammation
  • Biologic drugs, which block certain substances in your body that cause inflammation
  • Steroids, which mimic the hormone cortisol to help reduce inflammation


Surgery may be necessary in some cases. For example, hip replacement surgery may be an option for those with advanced hip arthritis. Other surgeries that some people with axSpA may need include:2

  • Spinal fusion to help stabilize the spine
  • Joint replacement to replace an arthritic joint
  • Osteotomy to repair bone problems

Complementary therapies

People with axSpA also may use other treatments to help them feel better. These are called complementary because they are used along with medical treatments. Complementary treatment options for people living with axSpA include:2,7,8

  • Acupuncture – Acupuncture is a form of traditional Chinese medicine. It helps reduce pain and inflammation by inserting thin needles into specific points in the body.
  • Massage therapy – Massage can help relax sore muscles and improve circulation. This, then, can reduce stiffness and pain.
  • Physical therapy – A physical therapist can work with you to find and treat areas with stiffness or pain.
  • Heat or cold therapy – Applying heat and cold packs to your joints can help improve flexibility and reduce inflammation.
  • Yoga – This practice combines physical poses, breathing exercises, and meditation. It can help improve flexibility, balance, and strength.
  • TENS unit – This medical device delivers small electric pulses to the affected areas for pain relief.
  • Herbs and supplements – Certain herbs and vitamin supplements may help to reduce inflammation. Examples include turmeric and omega-3 fatty acids.

Always talk to your doctor before starting any new treatments for axSpA.

General treatment suggestions

The Assessment of SpondyloArthritis International Society (ASAS-EULAR) updated its guidelines for treating axSpA in 2022. These guidelines are a step-by-step approach to axSpA treatment. They suggest trying exercise and lifestyle changes before taking medicines.3

The ASAS-EULAR recommends that people start with NSAIDs or DMARDs when they need medicine. If those do not work, they should try biologic medicines. The goal is to use the lowest effective dose of drugs to manage axSpA.3

Long-term use of steroids is not recommended. However, steroids injected directly into areas of inflammation may be used in some cases.3

Active versus stable axSpA

Treatment for axSpA will vary based on the severity of symptoms. Active disease is defined by pain, stiffness, fatigue, and other symptoms for at least 3 months. Stable disease is when these symptoms are not as frequent or intense.2,3

People with active axSpA may require more pain relievers and anti-inflammatory drugs. Those with stable axSpA may need only lifestyle changes. Physical therapy and daily exercise are recommended for both active and stable cases.2,3

Before beginning treatment for axSpA, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

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