• Discussing your treatment goals with your doctor can help improve your ankylosing spondylitis (AS) care.
• Treatment goals for AS may focus on particular symptoms, type of treatment, or improving daily functioning and quality of life.
• Researchers are examining how treatments can be effective for specific AS symptoms in order to improve treatment outcomes.

In general, treatment goals for people with ankylosing spondylitis are to relieve symptoms and prevent or slow disease progression. But your individual treatment goals may be more specific, depending on your particular diagnosis. Having a clear idea about your treatment priorities and communicating about them openly with your doctor can help you get the care you need and improve your sense of well-being.

As one MySpondylitisTeam member wrote, “My goal is not only to live my life but to do so despite the pain. The problem for me now is that it’s fairly new, and I’m still trying to find ways to still have quality without pain and fatigue.”

Ankylosing spondylitis is a type of inflammatory arthritis that causes bone damage and bone fusing primarily in the spine and sacroiliac joints. Symptoms of AS include low back pain, stiffness, and spine deformity. AS can be associated with other conditions, including uveitis (eye inflammation), inflammatory bowel disease (IBD), and psoriasis. AS is also known as radiographic axial spondyloarthritis (axSpA).

Treatment options for AS include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Conventional disease-modifying antirheumatic drugs (DMARDs) such as methotrexate
• Advanced treatment options such as biologic DMARDs, Janus kinase (JAK) inhibitors, or surgery

Treatment plans often include physical therapy and exercise to increase flexibility, strength, and mobility.

Over time, people with AS are likely to switch treatments because they find the drug no longer works, they’re dissatisfied with a drug or mode of taking a drug, or they can’t tolerate the drug’s side effects. Your treatment goals may also change over the course of time. If you aren’t achieving your treatment goals, it’s important to discuss this with your rheumatologist.

Read on to learn more about potential treatment goals. This may help you have better conversations with your doctor about your AS treatment options.

Achieving Remission

Understandably, achieving remission is a prime goal for people with AS. Rates of remission have improved with advanced treatments for AS. However, complete remission of symptoms — where symptoms go away entirely — is not likely for most people with AS.

Research shows that more than 30 percent of people who take biologic tumor necrosis factor (TNF) blockers — including drugs such as adalimumab (Humira) and etanercept (Enbrel) — go into partial remission, during which symptoms and disease activity are significantly decreased. JAK inhibitors including upadacitinib (Rinvoq) have also been shown to be effective in helping people with axial spondyloarthritis achieve partial remission.

With advanced treatments, such as biologics, you may need to try different drugs to determine which medication is the most effective for you. Biologics can also stop working over time if you develop antibodies that interfere with them. If you don’t feel that your symptoms are adequately controlled, your doctor may advise changing treatment plans by switching drugs, modifying dosage, or adding another medication.

Keep in mind that many drugs can take weeks or even months to reach their full effectiveness. In general, a three-month trial of any medication is adequate to decide if you should move on to a different treatment.

Increasing Energy

Fatigue is a common symptom with AS, but it’s not a trivial one. Fatigue can make all aspects of daily life and work difficult. If one of your treatment goals is to have more energy, it’s important to discuss fatigue with your doctor. Causes of fatigue can include:

• Lost sleep due to pain
• Depression
• An underlying condition such as a thyroid disorder or anemia

Appropriate physical activity and exercise can often help reduce pain and inflammation while improving sleep. Practicing relaxation techniques, such as meditation, and avoiding caffeine and late-night eating and drinking can also improve sleep.

If you have persistent fatigue, let your doctor know. They can review your medications with you and suggest other treatment options in order to help reduce disease activity that may be contributing to fatigue. Modifying your routine to combat fatigue is as important as taking your medications. Medications alone will not resolve your fatigue symptoms if the other lifestyle factors are not addressed.

Your doctor may advise testing for other health conditions, which may be causing or worsening fatigue and need to be treated along with your AS.

Preventing Bone Loss and Fractures

Bone health is a major concern for people with AS. Having AS increases your risk for vertebrae fractures and raises the risk of lower bone density and bone fractures in general due to:

• Disease inflammation
• Use of corticosteroids
• Other risk factors, such as low body weight

The risk of bone fractures increases particularly in postmenopausal individuals.

If you haven’t undergone a bone density scan (called dual-energy X-ray absorptiometry, or DEXA) it’s important to talk to your doctor about testing your bone health. Lower bone density causes an increased risk of osteoporosis, in which bones become porous, weak, and more prone to fracture. Physical therapy and appropriate exercise can help increase balance and strength in order to reduce the risk of falling. Smoking and excessive alcohol consumption are especially detrimental to bone health.

Treating the underlying inflammation of AS is important for maintaining bone health. Along with your AS treatment plan, your doctor may recommend taking supplements if your vitamin D and calcium levels are low. These levels can be assessed with a blood test.

If a bone density test indicates you have osteoporosis or osteopenia (bone weakness that can progress to osteoporosis), your doctor may recommend medication such as bisphosphonates. Bisphosphonates can treat bone density loss in some people.

Research suggests that people with AS who have vertebrae fractures can benefit from a multidisciplinary approach to their medical care, due to the risk of neurological problems when the spine is involved. Depending on a particular condition, multidisciplinary teams of doctors for vertebrae fractures might include:

• Rheumatologists
• Rehabilitation doctors
• Neurologists
• Neurosurgeons

You can ask your doctor more about multidisciplinary care.

Preventing Disability and Maintaining Mobility

Overcoming physical limitations and doing what you can to prevent disability are essential treatment goals for many people with AS. A key component to many AS treatment plans is physical therapy and exercise, which can help improve and maintain mobility and range of motion. This in turn can help prevent disability.

MySpondylitisTeam members frequently discuss physical therapy and exercise goals. “Went to physical therapy today and was excited to start again. It went well, and I set goals for working on my lower extremities, hips, back, and sacroiliac joint,” a member wrote.

Another member said, “Earlier I was having physical therapy. This is my second session. I realize I’ll have some muscle ache. My goal is to build muscle in my thigh and strengthen my hip.”

A physical therapist can help you learn safe exercises and guide you in physical activity that can help you with:

• Good posture
• Flexibility
• Daily functioning
• Deep-breathing exercises if ribs are affected by your AS

Although exercise may seem difficult at first due to stiffness and pain, research shows that it can help improve these symptoms while increasing physical function.

In cases of severe mobility problems, your doctor may advise hip replacement or laminectomy — a type of spine surgery — depending on your physical limitations and other symptoms. If surgery is a treatment option for you, be sure to thoroughly discuss the procedure, recovery, and potential risks.

Easing of Treatment

For some people with AS, the way a drug is taken can be a factor in setting treatment goals. Newer advanced medications such as JAK inhibitors are taken orally (by mouth), but TNF inhibitors must be taken by injection. These can be administered subcutaneously (under the skin), often by self-injection. They can also be administered via intravenous (IV) infusion at a clinic. Your dosage schedule and preferred mode of administration may narrow your options. Also keep in mind that your insurance may play a role in the decision-making process. Insurance companies sometimes have preferences as to which medications you can try first.

Understanding how and when a treatment must be taken is important. Having a treatment plan that can fit into daily life with as little disruption as possible may be an important treatment goal to discuss with your health care team.

Treatment Goals: What Are Endpoints?

Rheumatology researchers are trying to better assess how specific treatment goals can be reached. This type of research evaluates the endpoints — objective, measurable outcomes — of AS treatments. Rather than focusing on disease activity in general, newer studies are looking at how a particular AS therapy can reduce specific symptoms such as pain, spinal mobility, fatigue, and damage to peripheral joints besides the hip and spine. In the future, the results of these studies will better shape treatment goals in ankylosing spondylitis.

Talk With Others Who Understand

On MySpondylitisTeam, the social network for people with spondyloarthritis and their loved ones, more than 90,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondyloarthritis.

What are your treatment goals for ankylosing spondylitis? How do you talk to your doctor about your treatment goals? Share your advice in the comments below, or start a conversation by posting on your Activities page.