DEAR DOCTOR K:

I'd like to learn more about ankylosing spondylitis. What treatments will help manage my pain?

DEAR READER:

Ankylosing spondylitis is a form of arthritis that mainly affects the lower back. It causes inflammation and damage at the joints.

A person with ankylosing spondylitis commonly feels pain or stiffness in the lower back, especially in the morning or after periods of inactivity. Usually, back pain begins in the sacroiliac joint, between the spine and the pelvis. It works its way up the lower spine.

With time, inflamed spinal joints can fuse or grow together, causing an extremely stiff, rigid backbone. This may make it difficult to take a deep breath. Almost any movement can become extremely painful.

Men are more likely than women to be afflicted with this condition. The symptoms usually begin in early adulthood. There's definitely a strong genetic element to this disease. Almost all people with ankylosing spondylitis have a genetic marker called HLA B27; a simple blood test can detect it. X-rays and MRI scans can show the disease in its later stages, but only about a decade after the symptoms have begun.

What causes ankylosing spondylitis? All we know is that the immune system is "overactive" in the spinal joints, causing inflammation. We don't know why the immune system is provoked to cause this inflammation. Some experts think the immune system may be attacking an infection, but so far no specific infection has been found to be at fault.

Unfortunately, there is no cure. In fact, when I was in medical school, there were very few treatments proven to improve symptoms. The goal of treatment is to reduce joint pain and to prevent, delay or correct any damage or deformities of the spine and other joints.

Fortunately, today we have several effective medications: anti-inflammatory drugs such as ibuprofen or sulfasalazine, pain relievers (such as acetaminophen), or methotrexate.

And the remarkable new injectable medications -- adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade) and golimumab (Simponi) -- recently were approved for ankylosing spondylitis. These drugs appear to be more effective than older drugs for treating the condition.

Stiffness often improves with activity. As a result, treatment usually includes physical therapy and exercise. Your exercise routine should include range-of-motion and stretching exercises to help your spine remain flexible. Abdominal and back exercises can help you maintain good posture. Breathing exercises can help maintain your lung capacity.

Hot baths, heat and massage can help to relieve pain. If possible, sleep on your back on a firm mattress and use a small pillow or none at all.

Read more about strategies to address back pain in "Chicken Soup for the Soul: Say Goodbye to Back Pain" by Dr. Julie Silver of Harvard Medical School. Along with valuable information, it includes stories from many people like you. You can learn more about this book at AskDoctorK.com.

Even with the best treatment, you may develop a fused spine. At some point, a back brace or other devices, such a corset, cane or joint splints, may help.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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