Treatment of Non-Radiographic Axial Spondyloarthritis (nr-axSpA)

A common treatment regimen for the various forms of spondyloarthritis (ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, reactive arthritis, juvenile spondyloarthritis, and undifferentiated spondyloarthritis) involves medication, exercise, physical therapy, good posture practices, and other options such as applying heat/cold to help relax muscles and reduce joint pain. In severe cases, posture correcting surgery may also be an option.

Depending on the type of spondyloarthritis, there may be some variation in treatment. For example, in psoriatic arthritis, both the skin component and joint component must be treated. In enteropathic arthritis (spondylitis/arthritis associated with inflammatory bowel disease), medications may need to be adjusted so the gastrointestinal component of the disease is also treated and not exacerbated.

In 2015, the American College of Rheumatology, along with SAA and the Spondyloarthritis Research and Treatment Network, had published the first U.S. recommendations for the treatment of adults with axial spondyloarthritis (which encompasses ankylosing spondylitis and non-radiographic axial spondyloarthritis.) In August of 2019, physicians, scientists, patients, and other experts from the SpA community came together again to update these recommendations. Each recommendation is based on all available scientific evidence, and the expertise and experiences of rheumatologists and people with axial SpA. But you are unique, and there is no replacement for working with your doctor to design the best plan for you.

SAA was proud to play a critical role in their development, and is now proud to present key updates from the updated document for patients and loved ones, in clear and simple terms. This concise and informative overview was developed in close partnership with patients and physicians, and we hope you find it helpful.

2019 Treatment Guidelines Overview for Patients & Families

The American College of Rheumatology, the Spondylitis Association of America, and the Spondyloarthritis Research and Treatment Network published updated recommendations for treating ankylosing spondylitis (AS), and non-radiographic axial spondyloarthritis (nr-axSpA).

Developed in close collaboration with a volunteer team of patients, physicians, and other experts, this document presents key updates and specific treatment recommendations from the original manuscript, in clear and simple terms, so that you can better take charge of your treatment.

Updated 2019 Treatment Guidelines For Physicians

2015 Treatment Guidelines For Physicians

These huge accomplishments wouldn’t have been possible without the generous donations of our members and donors, as SAA provided the foundation funding for their undertakings, insisted that patients were active participants in the process, and has been closely involved in the projects.

Medications

There are a number of different types and classes of medications used in the treatment of ankylosing spondylitis and related diseases. Note that different people respond to different medications with varying levels of effectiveness. Thus, it may take time to find the most effective course of treatment.

About Medications

Exercise

Exercise is an integral part of any spondylitis program. Fitting exercise into your day can be tough, but it needs to be done. Exercise is such a high priority that you must make time for it each day (even five to10 minutes during a work break is helpful). If you do, many benefits will follow from your efforts. A spondylitis exercise program will help you maintain good posture, flexibility and eventually help to lessen pain.

About Exercise

Diet & Nutrition

In recent years, many specialized diets have gained popularity among some people with arthritis. To date, few of these claims have been substantiated by rigorously controlled studies. That said, some people find that certain foods trigger changes in symptoms –– either for the better or the worse. If you find yourself noticing this type of pattern, try keeping a food diary for a few weeks to test if indeed what you eat makes a difference or if you have food sensitivities.

About Diet & Nutrition

Complementary Treatments

The National Institutes of Health defines complementary and alternative medicine (CAM) as a group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine. CAM therapies used alone are often referred to as “alternative.” When used in addition to conventional medicine, they may be referred to as “complementary.” The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge.

About Complementary Treatments

Stress Reduction

Many people with spondylitis state that stress reduction is important to their ability to manage pain. Stress and anxiety can exacerbate symptoms, including contributing to an increase in pain. There are several modalities available to manage stress including medications, counseling, meditation, breathing techniques, tai chi, yoga, being in nature, massage, etc. For further reading see Anxiety and Pain by Dr. Glassman Spondylitis from our Winter 2010 issue of Spondylitis Plus and our book, Straight Talk on Spondylitis.

Heat/Cold

Applying heat to stiff joints and tight muscles can help reduce pain and soreness. Applying cold to inflamed areas can help reduce swelling and muscle inflammation. Hot baths and showers can also help provide relief.

Surgery

In severe cases of spondyloarthritis, surgery can be an option, especially hip joint replacement. Surgical correction is also possible for those with severe kyphosis (severe downward curvature) of the spine, particularly in the neck, although this procedure is considered risky.

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Related Resources

Answers to YOUR Spondyloarthritis Questions

Watch as rheumatologist Lianne Gensler, MD, answers the most common questions about SpA management at SAA’s Fall 2021 Spondyloarthritis Educational Seminar.

Yoga for Spondyloarthritis, Plus a Live Yoga Demo

Yoga is about much more than striking a pose – it’s a practice that offers a wealth of benefits for both mind and body. For those with spondyloarthritis (SpA), yoga can help ease pain, maintain mobility and flexibility, and lower stress, all of which can lead to improved quality of life.