6. Myth or Fact? People with Ankylosing Spondylitis Should Avoid Exercise

Absolutely not, another myth. A defined plan of physical therapy and individualized exercise is important for everyone with AS.

Back stiffness, especially in the morning, is one feature of AS that often improves with activity. People who have this disorder may get worse if they do not exercise regularly. The physician may send the patient to the physical therapist who can develop a plan of stretching, deep breathing and range-of-motion exercises. Hydrotherapy may be used as well.

Physical therapy can help to keep the back flexible, prevent stooping, make daily activities easier, and lower the chances of severe pain or further injury.

7. Myth or Fact? Drug Treatment for Ankylosing Spondylitis is Always Expensive

This is a myth, too. In fact, initial drug treatment can be quite affordable.

Drug treatment with anti-inflammatory NSAIDs or analgesics are usually the first drugs used for ankylosing spondylitis treatment. Treatament might include one of these medications:

  • ibuprofen (Advil)
  • naproxen (Aleve)
  • indomethacin
  • diclofenac (Cataflam)
  • celecoxib (Celebrex)
  • acetaminophen (Tylenol)

These drugs are readily available either over-the-counter (OTC) or with a prescription and most come in a low-cost generic option.

However, NSAIDs can be associated with serious side effects such as stomach bleeding, heart attack, and stroke – patients should discuss these side effects with their doctor, especially with long-term, chronic use of NSAIDs.

8. Myth or Fact? Ankylosing Spondylitis Leads to Severe Disability

Myth. Not everyone with ankylosing spondylitis has severe disease or physical disability – the disease course is variable and differs greatly among patients.

It is not a life-threatening disease and many people are able to work and function normally throughout their day. In most cases, AS is characterized by painful episodes followed by remissions, a time where the pain subsides.

Studies have shown that patients who have disease onset at an older age may be more prone to severe joint damage. In addition, smokers were more than four times as likely to have severe damage as nonsmokers.

For severe ankylosing spondylitis or other joint problems, surgery or joint replacement may rarely be required.

9. Myth or Fact? There is Little I Can Do to Help Myself

This statement could not be further from the truth.

Patients who are able to engage in an active lifestyle, maintain a regular exercise program and body weight, refrain from smoking, and keep up with clinic appointments and treatments will have a better outcome. A firm mattress may help to decrease morning stiffness. Some patients like to exercise in a pool or swim for exercise as it is easier on the joints.

Studies have shown a diet high in omega-3 fatty acids (found in cold water or oily fish like salmon, flax seeds, and walnuts) can reduce joint inflammation in rheumatoid arthritis patients, and there is some evidence it might be helpful in ankylosing spondylitis, as well.

10. Myth or Fact? If NSAIDs Don’t Work, I’m Out of Options

Definitely not true. The biologics, or tumor necrosis factor (TNF)-alpha inhibitors (TNF blockers), can play a key role in those who do not respond to NSAIDs. TNF blockers can lead to less back pain, stiffness, and inflammation; they may also slow progression of AS. TNF blockers may be used in conjunction with NSAIDs for symptom control.

FDA-approved biologics for ankylosing spondylitis include:

  • Humira (adalimumab) and its biosimilars: Amjevita(adalimumab-atto) approved in September 2016, Cyltezo(adalimumab-adbm), approved in August 2017, and Hyrimoz, (adalimumab-adaz) approved in October 2018.
  • Cimzia (certolizumab)
  • Enbrel (etanercept) and its biosimilar Erelzi (etanercept-szzs)
  • Remicade (infliximab) and its biosimilars: Inflectra (infliximab-dyyb), Renflexis (infliximab-abda), or Ixifi (infliximab-qbtx).
  • Simponi (golimumab)

They are administered in the clinic or given by self-injection at home. Some patients with AS may see results as soon as 2 weeks, but for others it may take several months.

Cochrane Review from Maxwell and colleagues concluded that there is moderate to high quality evidence that anti-TNF agents improve clinical symptoms in the treatment of ankylosing spondylitis.

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