Ankylosing Spondylitis: Treatment Options and When to Consider Surgery - Orthopedics

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Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. It can also affect other joints and organs, such as the eyes, as you have experienced with your iritis. The condition is characterized by periods of flare-ups and remission, and while there is no cure, various treatment options are available to manage symptoms and improve quality of life.


Treatment Options for Ankylosing Spondylitis
1. Medications:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are often the first line of treatment for AS. They help reduce inflammation and relieve pain. Common NSAIDs include ibuprofen and naproxen.

- Disease-Modifying Antirheumatic Drugs (DMARDs): If NSAIDs are insufficient, DMARDs like sulfasalazine may be prescribed, especially if peripheral joints are involved.

- Biologic Agents: For more severe cases, biologics such as TNF inhibitors (e.g., etanercept, infliximab) or IL-17 inhibitors (e.g., secukinumab) can be effective in reducing inflammation and slowing disease progression.

- Corticosteroids: These may be used for short-term relief during flare-ups but are not recommended for long-term use due to potential side effects.

2. Physical Therapy: Regular exercise is crucial for maintaining flexibility and posture. Physical therapy can help develop a tailored exercise program that focuses on stretching and strengthening the back and core muscles.

3. Lifestyle Modifications:
- Exercise: Engage in regular physical activity, including swimming, walking, and yoga, which can help maintain mobility and reduce stiffness.

- Posture: Maintaining good posture can help alleviate pain and prevent further complications.

- Heat and Cold Therapy: Applying heat can help relax tense muscles, while cold packs can reduce inflammation.

4. Surgery: Surgery is generally considered a last resort for AS. It may be indicated in cases of severe spinal deformity, significant loss of function, or when conservative treatments fail to provide relief. Surgical options may include spinal fusion or joint replacement, but these procedures come with risks and should be carefully considered.


When to Consider Surgery
Surgery for ankylosing spondylitis is not common and is typically reserved for specific situations, such as:
- Severe spinal deformity: If the curvature of the spine becomes pronounced and affects daily activities.

- Uncontrolled pain: If pain is debilitating and does not respond to other treatments.

- Neurological symptoms: If there is compression of the spinal cord or nerves leading to weakness, numbness, or loss of bowel or bladder control.

Given your symptoms, including increasing back pain and chest discomfort, it is essential to consult with a rheumatologist or a spine specialist. They can perform a thorough evaluation, including imaging studies, to assess the extent of your condition and determine the best course of action.

Conclusion
While surgery can be an option for some patients with ankylosing spondylitis, it is typically not the first line of treatment. It is crucial to manage the condition with medications, physical therapy, and lifestyle changes. If your symptoms worsen or if you experience significant functional impairment, a surgical consultation may be warranted. Always discuss your concerns and treatment options with your healthcare provider to make informed decisions tailored to your specific situation.