The above picture is a classic image in the rheumatology literature showing a young man with ankylosing spondylitis progressively developing severe deforming disease as he gets older. In fact the majority of people with AS do not have this sort of progression, but a subset of people who have more severe disease are at risk for this. It’s hard to determine who is at risk for this sort of severe manifestation, but some early findings can be suggestive. If you already have significant damage on X-ray, cat scan, or MRI, that may be a clue that you’re at higher risk for more damage in the future. If you have significant limitations in range of motion of your spine, limitations in your ability to exercise and perform usual activities of daily living, these may also indicate a risk of further disability and limitations going forward. Lastly, if you’re not responding to mild treatments for AS, such as anti-inflammatory medications, omega 3 supplementation, and regular exercise, then you may be at risk for further progression long term.
So how can we bend the curve of disease progression in AS? Until recently it was hard to tell someone with AS with certainty that medication can prevent this progression. However, results from a recently published multicenter trial showed that treatment with medication that blocks the chemical tumor necrosis factor can prevent progressive X-ray changes in ankylosing spondylitis. This prevention of structural damage will help to maintain functional ability as well. We also know that these same meds can dramatically improve pain in AS patients.
If you have ankylosing spondylitis, first and foremost make sure you are doing all the safe, conservative, and helpful interventions that all AS patients should be doing. If that is not sufficient, then strongly consider a medication that can help prevent progression of the disease and that works better in regards to pain control than any other treatments we currently have available.