Treatment Modalities of Ankylosing Spondylitis

Abstract

Ankylosing spondylitis is a chronic inflammatory arthropathy of young adults which primarily affects the axial skeleton. The pathogenesis of AS is unclear, but it is thought to be caused by an early inflammatory phase followed by ossification that may induce local osteitis. It has also been linked to an increase in morbidity and mortality and is known to have a debilitating impact on QoL of the patients. Whereby, CRP and ESR are used for assessment of the disease activity and determination of treatment efficacy, HLA-B27 is considered the best biomarker for AS diagnosis. The conventional therapeutic regimen like NSAIDs and DMARDs alone are not effective in controlling symptoms and indicators of disease; however, when combined with the physical therapy, great improvement in the QoL of the patients has been observed. The outlook for AS has improved remarkably with the advent of biologics that blocks key inflammatory cytokines such as TNF inhibitors. Biologics aids in halting disease progression, and can be used concomitantly with other medications for pain management. In this chapter, barring surgical interventions, we will discuss about the non-pharmacological and pharmacological therapies routinely employed for the treatment of AS, as well as the novel therapeutics currently under study.