Managing spondyloarthritis

There is no cure at present for spondyloarthritis but with the proper management of the disease from as early a stage as possible; patients can live fully productive lives.

The primary management of spondyloarthritis falls into two categories, Pharmacologic (medication) therapy and Exercise. In certain cases, surgery may be considered a beneficial option.

Pharmacological therapies

The first line of treatment for spondyloarthritis is NSAIDS. Many patients can do well on NSAIDS, but if NSAIDS alone do not help relieve symptoms, there are relatively new drugs (first introduced in 1998 in the USA) drugs called biologics or TNF inhibitors (TNFi). These drugs can be very effective for most patients (about 70%) and can dramatically slow the progression of disease.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are used for both axial and peripheral spondyloarthritis to reduce inflammation. There is evidence that regular intake of NSAIDs can slow the progress of Ankylosing Spondylitis in patients with risk factors.

Disease modifying anti-rheumatic drugs (DMARDs)

For peripheral spondyloarthritis, DMARDs such as sulfasalazine and methotrexate may be prescribed. DMARDs have little or no effect on spinal disease.

Local corticosteroids

Local corticosteroid injections may be used in peripheral arthritis to reduce inflammation.

TNF blockers or inhibitors, also known as anti-TNF biologics (TNFi)

TNF stands for tumor necrosis factor, a pro-inflammatory molecule released by one’s own immune cells. TNF is inappropriately released in patients with autoimmune inflammatory diseases. TNFi drugs bind and neutralize TNF, reducing inflammation.

Each of the biologics approved in Canada are slightly different from each other but have about the same effectiveness. They are taken by below skin injection or intravenous infusion.

As the patents on TNFi are ending, other companies are manufacturing biologics with similar properties. These are known as biosimilars or Subsequent Entry Biologics (SEBs).

It is important to be informed about biosimilars as they are not the same as the original entry drugs. Studies comparing the efficacy and toxicity of the innovators and biosimilars can help establish equivalence and bring out differences if any.


Analgesics (pain killers) may be prescribed in conjunction with NSAIDs, DMARDs or Biologics to help relieve pain.


It cannot be overemphasized how important exercise is to the management of Spondyloarthritis. Movement can help relieve pain and stiffness.

Any exercise is better than no exercise unless you are in the midst of a flare. Supervised exercise and group exercise are more effective than exercising at home because you are more motivated in a supervised or group setting.

Exercise means moving. There are always stretches that you can do while sitting or lying down. More active forms of exercise are beneficial provided they are low impact, for example, walking or swimming, and are done on a regular basis.

There is no preferred form of exercise because the benefits of all exercise are about the same. Nevertheless, be mindful of the need to do stretching exercises to maintain posture and flexibility.

A physiotherapist can help you with a suitable program of stretching and exercising. Spinal extension could help reduce the chances of developing a stopped posture. Even if there is ongoing fusion of the spine, with regular spinal extension exercises, the impact on posture could be minimized.

If you start an exercise program, first check with your health care provider. Start slowly and do not push yourself to the point of pain. Gradually build up your strength and stamina. Set realistic goals and establish a regular routine.


In some patients surgery may be beneficial. Extreme stooped posture can result in difficulty with vision and gait. If the cervical or upper thoracic spine is fused and bent, vertebral osteotomy (straightening of the spine) may help the patient lead a more normal life.

Surgery may also be beneficial in fracture stabilization and joint replacement where the patient has significant involvement of the hips.