Ankylosing Spondylitis

What is ankylosing spondylitis?

Ankylosing spondylitis is a chronic inflammatory condition where the immune system mistakenly targets the joints in the spine. It most often begins in the sacroiliac joints and can gradually affect the lower, mid, and upper spine.

If not treated, ongoing inflammation can lead to permanent damage and, in some cases, fusion of the spine. This may cause pain, stiffness, and reduced flexibility over time.

Symptoms often develop gradually and may include:

Chronic low back pain (lasting more than 3 months)
Morning stiffness that improves with movement
Pain that improves with activity and worsens with rest
Pain in the buttocks (often alternating sides)

Some people may also experience inflammation in other areas, such as the eyes (uveitis), joints, or tendons (enthesitis).

RheumInfo: Ankylosing Spondylitis

https://rheuminfo.com/en/diseases/ankylosing-spondylitis/

Arthritis Society: Ankylosing Spondylitis

https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/ankylosing-spondylitis

How is ankylosing spondylitis treated?

The first step in treating ankylosing spondylitis includes physiotherapy—with a focus on posture and core strengthening—along with anti-inflammatory medications (NSAIDs). Common NSAIDs include ibuprofen, naproxen, celecoxib, indomethacin, and meloxicam.

Exercise in ankylosing spondylitis

https://spondylitis.org/about-spondylitis/treatment-information/exercise/

What advanced therapies are available?

If you continue to have symptoms despite physiotherapy and NSAIDs, there If you continue to have symptoms despite physiotherapy and anti-inflammatory medications (NSAIDs), biologic medications may be recommended.

Biologics are targeted treatments that work on specific parts of the immune system involved in ankylosing spondylitis. While these medications are expensive (often over $1,000 per month), they are covered by B.C. PharmaCare for patients who meet certain criteria.

To qualify, you must:

Have a diagnosis of ankylosing spondylitis
Have tried at least two different NSAIDs at maximum doses for a minimum of two weeks each
Have ongoing active disease

If you are eligible, your rheumatologist will complete the necessary PharmaCare paperwork to help you access treatment.

Which biologics are used?

There are three main types of biologic medications that are covered by B.C. PharmaCare. Other biologic options are available to treat ankylosing spondylitis, but they are not currently funded through PharmaCare.

TNF inhibitors
- Adalimumab (self-injection once every 2 weeks)
- Certolizumab (self-injection once every 2 weeks)
- Etanercept (self-injection once per week)
- Golimumab (self-injection once per month)
- Infliximab (infusion once every 2 months)
IL-17 inhibitors
- Secukinumab (self-injection every month)
- Bimekizumab (selft injection every month)
JAK inhibitors
- Tofacitinib (pill twice per day)

There are several types of medications that work well to treat ankylosing spondylitis. At this time, we cannot predict which one will work best for each individual. Your medical history and other health conditions may help guide the choice of treatment.

Because these medications work by calming the immune system, they can slightly increase your risk of infections. Most infections are mild, such as colds or sinus infections.
If you develop an infection that requires antibiotics, you should pause your medication until the infection has cleared and you have completed your antibiotics.
If you are planning to have major surgery, these medications are usually held beforehand. This helps reduce the risk of infection and supports proper wound healing. They may not need to be stopped for minor procedures. Please speak with your rheumatologist if you have an upcoming surgery or any questions about your medications.