Diagnosis
During the physical exam, your healthcare provider might ask you to bend in different directions to test the range of motion in your spine. Your provider might try to reproduce your pain by pressing on specific portions of your pelvis or by moving your legs into a particular position. You also may be asked to take a deep breath to see if you have difficulty expanding your chest.
Imaging tests
X-rays allow doctors to check for changes in joints and bones, also called radiographic axial spondyloarthritis, though the visible signs of ankylosing spondylitis, also called axial spondyloarthritis, might not be evident early in the disease.
Magnetic resonance imaging (MRI) uses radio waves and a strong magnetic field to provide more detailed images of bones and soft tissues. MRI scans can reveal evidence of non-radiographic axial spondyloarthritis earlier in the disease process, but they are much more expensive.
Lab tests
There are no specific lab tests to identify ankylosing spondylitis. Certain blood tests can check for markers of inflammation, but many different health problems can cause inflammation.
Blood can be tested for the HLA-B27 gene. However many people who have the gene don't have ankylosing spondylitis, and people can have the disease without having the HLA-B27 gene.
Treatment
The goal of treatment is to relieve pain and stiffness and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage.
Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) - such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others) - are the medicines health care providers most commonly use to treat axial spondyloarthritis and nonradiographic axial spondyloarthritis. These medicines can relieve inflammation, pain, and stiffness, but they also might cause gastrointestinal bleeding.
If nonsteroidal anti-inflammatory drugs (NSAIDs) aren't helpful, your doctor might suggest starting a tumor necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor. These medicines are injected under the skin or through an intravenous line. Another option is a Janus kinase (JAK) inhibitor. Janus kinase (JAK) inhibitors are taken by mouth. These types of medicines can reactivate untreated tuberculosis and make you more prone to infections.
Examples of tumor necrosis factor (TNF) blockers include:
Adalimumab (Humira).
Certolizumab pegol (Cimzia).
Etanercept (Enbrel).
Golimumab (Simponi).
Infliximab (Remicade).
Interleukin-17 (IL-17) inhibitors used to treat ankylosing spondylitis include secukinumab (Cosentyx) and ixekizumab (Taltz). Janus kinase (JAK) inhibitors available to treat ankylosing spondylitis include tofacitinib (Xeljanz) and upadacitinib (Rinvoq).
Therapy
Physical therapy is an important part of treatment and can provide several benefits, from pain relief to improved strength and flexibility. A physical therapist can design specific exercises for your needs. To help preserve good posture, you may be taught:
Range-of-motion and stretching exercises.
Strengthening exercises for abdominal and back muscles.
Proper sleeping and walking positions.
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