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Myths and Facts About AS Treatment

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Ankylosing spondylitis (AS), which can cause pain and severe stiffness, can be successfully managed, but myths about the condition still persist — and they might be preventing you from getting the treatment you need.

Some people think AS is rare, but it’s not, says Eric L. Matteson, MD, chair of rheumatology at the Mayo Clinic in Rochester, Minnesota. AS is the most common inflammatory rheumatic disease in the family of spondyloarthritis, a group that differs from other types of arthritis because symptoms occur in the sites where ligaments and tendons meet the bone, according to the American College of Rheumatology.

AS typically affects the joints in the spine, but it may also affect the hips, knees, and even organs such as the aorta (the body’s main artery) and the eyes, Dr. Matteson says. Treatment may include anti-inflammatory drugs, biologic medications such as tumor necrosis factor inhibitors, corticosteroids, or surgery, according to the Arthritis Foundation (AF).

Doctors don’t know the cause of AS, which tends to come on between the ages of 17 and 45 and is more common in men, but they believe that having a genetic marker called HLA-B27 puts some people at higher risk for the disease, as do gastrointestinal infections and a family history of the condition, the Spondylitis Association of America (SAA) suggests.

For anyone who has AS, a first step in getting the right treatment is learning to separate fact from fiction. Start here.

Fact: Early diagnosis of AS is important.

People who receive treatment within two years of being diagnosed with AS are more likely to have a better outcome and achieve remission than those who delay getting diagnosed, says Susan M. Goodman, MD, a rheumatologist at the Hospital for Special Surgery in New York City. When researchers looked at data on 105 people with spondyloarthritis, those who had delayed diagnosis and treatment experienced worse symptoms, had more trouble with spinal mobility and functioning, had more damage, and didn’t respond as well to treatment, according to a study published in August 2015 in the journal Clinical Rheumatology.

Myth: People with AS will eventually have a deformity.

Although spinal fusion is possible, it’s only needed in severe cases. “Deformity is definitely not inevitable,” Dr. Goodman says. It can usually be avoided with early treatment and lifestyle changes, such as doing extension exercises and sleeping without a pillow, she says.

Fact: The specialist for treating AS is a rheumatologist.

Rheumatologists specialize in diagnosing and treating diseases related to the joints along with the tendons, ligaments, connective tissue, bones, and muscles, according to the SAA.

Myth: If you have AS, you’ll most likely need surgery.

Surgery is rarely done for people with AS, Goodman says. In severe cases, joint replacement in the knees or hips or surgery to correct a curved spine may be needed, according to the SAA.

Fact: Basic treatment for AS is similar to that of other inflammatory conditions.

Typical treatments for AS include over-the-counter or prescription pain relievers, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and disease-modifying antirheumatic drugs (DMARDs), including biologic medications, according to the AF.

Myth: Exercise will make AS more severe.

“Sometimes people have the misconception that exercise will worsen AS,” Matteson says. But that’s not true. In fact, people with AS tend to feel better after exercise, the SAA says. Exercise can help keep you flexible, improve posture, and may lower pain, and the SAA recommends including daily exercise in every treatment plan for AS. Researchers who reviewed six studies involving 1,098 people with AS found that people who exercised at home appeared to have less pain and depression and had better quality of life than those who did not. Their findings were published in October 2015 in the journal Clinical Rheumatology.

Fact: Spinal fusion for AS isn’t reversible.

People with AS tend to experience inflammation where the ligaments attach to the bone. One of the consequences is that there could be tissue scarring when the body heals from the inflammation, which may result in extra bone forming. Over time, the ligaments may become bony and fuse in the spine, forcing people into a stooped position. This type of damage isn’t reversible, Dr. Goodman says. However, drug treatments may be able to prevent the fusion of the spine from progressing, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Myth: AS is curable.

There’s no cure for AS, but early treatment with a combination of NSAIDs and biologic medications is the best way to achieve remission, Goodman says. “The word ‘cure’ may be misleading, as it implies a drug-free state, which is rarely achieved,” she says. But that doesn’t mean you can’t live well with AS when you’re getting the right treatment.






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Date: 06.12.2018, 14:56 / Views: 92365