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Ankylosing Spondylitis


Ankylosing spondylitis (AS) is a chronic inflammatory disease that causes pain and inflammation of the joints of the spine and the joints between the spine and pelvis (sacroiliac joints). However, AS may also involve other parts of the body as well. AS and its related diseases affect as many as 2.4 million people in the United States. AS commonly occurs in people between the ages of 17-35, but it can affect children and older adults. AS is more common in men, but occurs in women as well. Although the exact cause of AS is unknown, we do know that genetics, along with some environmental factors, play a key role in AS.

The first symptoms of AS are frequent pain and stiffness in the lower back and buttocks, which comes on gradually over a period of a few weeks or months. This pain and stiffness is usually worse in the mornings and during the night, and improves with light exercise. Some patients with AS can also have inflammation in their tendons and other joints of the body. In patients with advanced disease, inflammation can cause the spine to fuse in a fixed, immobile position, sometimes creating a forward-stooped posture.

The goal of treatment is to relieve pain and stiffness, and prevent or delay complications and spinal deformity. Nonsteroidal anti-inflammatory drugs (NSAIDs) are initially used to reduce inflammation and pain. Other drugs used are sulfasalazine or methotrexate . These drugs, however, are not as effective in controlling inflammation in the spine. Newer drugs, called TNF-inhibitors have been shown to improve the symptoms of AS. These include medications such as Humira, Enbrel, Simponi and Remicade. Recently, it has been shown that these drugs control symptoms but there is still some residual inflammation seen on MRI of the SI joints in patients with AS. Symptoms reoccur on stopping these medications. There are ongoing trials to find more effective and longer lasting medications for these patients.

The physicians at Arizona Arthritis and Rheumatology Associates see a lot of patients with Ankylosing Spondylitis. We also have a research arm, AARR, which is dedicated in helping to develop newer drugs which can be more effective and less expensive for our patients. We would like to encourage patients with AS to call our office if they are interested in treatment and in participating in one of our clinical trials for AS.

Cortisone (e.g. prednisone) and NSAIDs e.g. ibuprofen, naproxen can help symptoms but do not have the ability to modify the joint destruction and functional decline. They may cause stomach bleeding, poor kidney function, high blood pressure and cardiovascular side effects among other side effects.

Disease modifying anti-rheumatic drugs (DMARDs) have the capacity to drive the disease to a low activity state. The gold standard methotrexate at 15-25 mg per week, Arava, sulfasalazine, and the less potent Plaquenil are examples. But they often fail to induce remission. Newer biologic agents especially when used with methotrexate can affect good clinical outcomes. They include Enbrel, Remicade, Humira, Orencia, Rituxan, Cimzia, Simponi, and Actemra (listed in the order of approval by the FDA). However, even on these agents most RA patients do not achieve remission and they also may cause mild and serious side effect which limit their use. More research is needed to refine treatments with these agents and to identify new more effective, safe and less expensive drugs to help patients with RA. Only when RA patients volunteer for clinical research trials are better therapies discovered.

The physicians in practice at Arizona Arthritis & Rheumatology Associates and their research division Arizona Arthritis & Rheumatology Research are dedicated to the care of patients with RA. They helped develop the available RA therapies and are investigating new drugs on the horizon. We encourage patients with RA to contact us to participate in our growing research efforts and to become patients of our cutting edge rheumatology center.