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Talk About Advanced AS Treatment

Getting the Ankylosing Spondylitis Care You Need

If you are living with advanced ankylosing spondylitis (AS), you might be wondering what you and your rheumatologist can do to manage your AS symptoms and prevent disease progression.

Fortunately, there is plenty you can do to manage back pain and stiffness linked to AS. Making changes to your current treatment plan, including taking stronger medicines, can help you to feel better, get around more easily, and reduce the potential for severe problems, such as mobility issues and disease complications like eye and nerve problems.

Here, we will break down when it might be time for stronger treatments, what your options are, and things to consider as you make these decisions. You should also take some time to prepare for your discussion with your healthcare provider (HCP) by thinking about your specific symptoms and pain points.

Prepare For Your Visit

Working with your rheumatologist or other healthcare provider is vital to reducing ankylosing spondylitis complications, joint damage, and spine problems. Prepare for your visit by thinking about specific symptoms and pain points ahead of time. This personalized guide will help you to start the discussion and work towards an effective treatment plan that helps you to find relief.

When to Reconsider Your Treatment Plan

Some people with AS may experience a rapid progression while others experience a mild disease or slower progression.

If you are consistently experiencing pain, stiffness, and other signs of inflammation in your low back, hips, and other joints, or have other ongoing symptoms of AS, it is time to talk to your healthcare provider about advanced treatment options. Medications like NSAIDs and TNF inhibitors are standard. Depending on the case, IL17 inhibitors and JAK inhibitors may also be options.

Advanced AS can cause joint damage and disability. Chronic, ongoing inflammation eventually leads to bone loss. And when there is new bone tissue growth, new bony growths develop in the areas where ligaments and tendons attach to the joints.

As AS develops and worsens, the spine can become stiff and difficult to move. In addition, ongoing changes to the spinal column will eventually make the spine weak and increase the risk for fractures of the vertebrae (the small bones forming the backbone).

Advanced AS might also mean a higher risk for spine curvature, scarring between the joints of the spine and ribs, breathing problems, neurological issues, and other problems related to inflammation. For some people, it may mean a fused spine from new bone growth between the vertebrae joining them together. The worse this becomes, the more reduced the movement of the spine becomes. 

Additional signs of progressing AS, and signs you will want to address with your healthcare provider, might include: 

  • Kyphosis: This is where the spine becomes abnormally curved and causes a person to hunch forward. This occurs because the muscles of the spine have become weakened, and the vertebrae fused.
  • Autoimmune disease: Patients may experience psoriasis and/or inflammatory bowel disease.
  • Difficulty with breathing: Advanced AS can cause the joints of the ribs and breastbone to become stiff, affecting the ability to breathe deeply.
  • Fractures: Bones and joints that have become damaged or weak can break more easily. Fractures of the spine can damage the spinal cord and the surrounding nerves.
  • Heart issues: The same inflammation that affects the spine can also spread to your heart and damage your aorta—the main body artery that carries oxygen-rich blood from the left ventricle of the heart to the rest of your body. A damaged aorta can impair the heart’s ability to function properly.

Your Therapy Options

Treatment for AS focuses on reducing inflammation, relieving pain and stiffness, and keeping the condition from getting worse. Treatment usually starts with first-line therapies, including nonsteroidal anti-inflammatory drugs (NSAIDs), physical and occupational therapy, and the use of assistive devices. When first-line treatments fail or your AS becomes severe, your doctor may recommend one of several options.

Treatment for AS also involves treating disease complications as they occur. This includes uveitis (eye inflammation), cauda equina syndrome (spine compression), amyloidosis (protein buildup in the organs), and traumatic fractures and dislocations.

What to Consider

There is plenty to think about and consider when making treatment decisions for ankylosing spondylitis. Let’s discuss the most common concerns related to your AS treatment and how your healthcare provider can help.

  • Worries About Side Effects: Your doctor has prescribed your AS treatments because they feel the benefits outweigh the risks. Talk to your doctor to discuss any concerns you may have about treatment so the two of you can work together to choose treatments that work effectively with the least amount of side effects.
  • A Fear of Needles: Injectable biologic drug therapies target specific parts of the immune system, which makes them an effective treatment for AS. But injecting yourself can be a daunting task. If injection pain is a concern for you, talk to your doctor about how you can inject yourself safely and painlessly.
  • Being Patient With Treatment Response: A new treatment can take up to 3 months for the drug to take effect and start improving your condition. There might be times when you may need to try several treatments before you find one that best works. Remember to be open-minded and flexible when starting a new treatment, and reach out to your doctor with questions about your treatment plan.
  • Feeling Like You Need to Compromise for Relief: If you are experiencing severe or ongoing side effects, or if you feel your condition is worsening, reach out to your healthcare provider. You are not required to push through with a medication that is not helping or negatively affecting your life.
  • Concerns About Cost: Ankylosing spondylitis treatments can be expensive. Fortunately, many drug manufacturers offer financial assistance programs to assist with drug costs and co-pays for biologic and systemic drug therapies. Prescription savings programs, including GoodRx and RxAssist, can also reduce your AS treatment costs. You can find more information online or through your healthcare provider's office.

The best way to manage severe symptoms and complications of AS is to talk to your healthcare provider, discuss options, and follow your treatment plan prescribed.