Injectables treat form of arthritis

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.

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.

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