Treatment for ankylosing spondylitis (AS) aims to achieve and maintain remission. When in remission, disease activity such as inflammation, joint stiffness, and pain is low or minimal.
AS is a type of arthritis that causes swelling and pain in the spine and the sacroiliac joint. This joint connects the bottom of the spine to the pelvis. AS can also affect other joints in the body.
The Spondylitis Association of America estimates that AS affects about 3.2 million people in the United States.
AS symptoms come and go. Like other forms of arthritis, there is no cure for the condition but treatments may help minimize symptoms and improve a person’s quality of life. Treatment may help someone with AS experience a state of remission.
This article discusses the definition of AS in remission, AS treatments, and people’s potential outlook.
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AS in remission indicates that there is either low disease activity or no disease activity at all.
When in remission, AS causes minimal to no inflammation or negative impact on a person’s daily function.
A person experiencing AS remission may observe a delayed progression of structural damage along with better health outcomes. These may include improvements in the following aspects of a person’s life:
- physical function
- health-related quality of life
- work productivity
Remission criteria
Healthcare professionals, such as rheumatologists, may use different criteria to measure remission in people with AS.
Two common criteria are the:
- Ankylosing Spondylitis Disease Activity Score (ASDAS)
- Assessment of Spondyloarthritis International Society (ASAS) Response Criteria
ASDAS defines inactive disease based on a formula that considers five factors:
- back pain severity
- duration of morning joint stiffness
- patient global assessment, which is a self-reported measure of a person’s perceived disease activity or overall health
- peripheral joint complaints
- C-reactive protein or erythrocyte sedimentation rate levels
According to the ASAS, a person’s ASDAS score determines their disease activity:
| ASDAS score | Disease activity |
|---|---|
| less than 1.3 | inactive disease |
| 1.3–2.0 | moderate disease activity |
| 2.1–3.5 | high disease activity |
| greater than 3.5 | very high disease activity |
Meanwhile, the ASAS defines partial remission criteria based on a 0–10 scale in
- function
- pain
- inflammation
- patient global assessment
To have partial remission in the ASAS scale, a person must score 2 or less in each domain.
The primary goal of AS treatment is for a person to experience remission and manage any symptoms. According to the Arthritis Foundation, AS treatment focuses on:
- relieving pain
- maintaining spinal structure
- preventing organ and joint damage
- preserving joint mobility and function
- improving a person’s quality of life
Generally, this involves a combination of lifestyle strategies, physical therapy and exercise, and medications. However, in rare cases, a person with AS may benefit from surgery.
Read more about possible complications of AS.
Lifestyle strategies
The Arthritis Foundation advises against smoking because it may speed up AS disease activity and joint damage. A person can speak with a healthcare professional for support if they decide to quit smoking.
The Arthritis Foundation also recommends:
- practicing good posture
- stretching
- taking breaks on difficult days to manage fatigue
- eating a balanced, nutrient-dense diet
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Eating foods with anti-inflammatory properties, like polyunsaturated fatty acids, may help reduce disease activity in people with AS.
However, a person should consult a healthcare professional for guidance before significantly changing their diet.
Learn more about foods to eat and avoid with AS.
Medications
Doctors may recommend the following medications for people with AS:
- nonsteroidal anti-inflammatory drugs
- other pain relief medications, such as acetaminophen
- corticosteroids
- sulfasalazine, a type of disease-modifying antirheumatic drug (DMARD)
- certain biologics, which are a type of DMARD, such as interleukin (IL-17) inhibitors and tumor necrosis factor inhibitors
Exercise and physical therapy
Regular physical activity may help prevent joint stiffness and limited range of motion in the neck and back.
Activities such as yoga, tai chi, swimming, and walking may help with posture and flexibility. A person with AS may also benefit from core and leg strengthening exercises.
A physical therapist can help a person create an exercise plan and teach them how to stretch and strengthen their muscles. Additionally, an occupational therapist may prescribe assistive devices and offer tips to help protect joints and make daily tasks easier.
Most people living with AS maintain the ability to work and stay fully functional.
However, those with a more severe, long-standing disease have
Similarly, those who developed AS at a younger age tend to have poorer functional outcomes, which may include physical disabilities.
A person with AS can speak with a doctor about their individual outlook.
A healthcare professional may use the term “AS remission” to indicate that there is either low disease activity or no disease activity at all.
AS treatment aims to achieve and maintain remission to prevent structural damage and functional limitation. A combination of medications, exercise, and lifestyle strategies may help a person experience AS remission.
A person with AS can speak with their doctor about which treatments may work best for them.