Treatment for Spondylitis

Treatment for spondylitis is individualized according to how severe the disease is and whether there are complications. Generally, treatment should consist of education and counseling, physical therapy and exercise, as well as medication if needed.

Education and Counseling

Even in its mild forms, spondylitis can affect your normal daily routines. So it's important to learn all about your disease, so you can be prepared for the ups and downs that will come with it.

Also, consider letting your teachers and other school personnel know about your spondylitis, in order to make them aware of any special needs you may have - such as seating and the need to stretch. (See the School section for more tips and information on special accommodations in school.)

Attitude is important when dealing with a chronic illness, and sustaining a positive outlook can be difficult. Spondylitis can take a toll emotionally as well as physically, but teens living with it will find that they can manage their disease easier with a positive outlook and attitude. (See the Friends and Family section for more information on attitude and outlook.)

Some people may find that talking with a counselor is helpful by talking about some of the difficulties that spondylitis can produce. You can always talk to a counselor at school or ask your parents for help in finding a psychologist to speak with.

Physical Therapy and Exercise

Areas of physical activity that are important to emphasize include stretching exercises, posture and daily exercise. Simple stretching exercises for the range of motion in the chest, back and other joints may be helpful depending on the specific joints affected. Paying attention to posture will keep the head, shoulders and back well aligned and will help reduce pain and fatigue.

Whenever possible, you should participate in gym and other physical activities. Before returning to a physical activity, make sure all concerned parties such as teachers and coaches are informed of any limitations you may have.

Regular daily activities such as walking, bicycle riding, and swimming should be encouraged, but it is important to know that these activities are not a substitute for prescribed physical therapy, particularly when the disease has already affected mobility. Decisions to pursue more vigorous physical activity such as contact sports should be made after consultation with a pediatric rheumatologist and physical therapist.

Some people also benefit from things like shoe inserts, which may help relieve heel and foot pain, or splints for affected joints can help prevent and/or treat joint contractures.

(See the Staying Active section for more information.)

Medication

Often, the first type of medication used for spondylitis is a non-steroidal anti-inflammatory drug (NSAID). These drugs include naproxen (Naprosyn), ibuprofen (Advil), tolmetin (Tolectin), and in older patients, indomethacin (Indocin) or diclofenac (Voltaren); other NSAIDS are sometimes used as well.

All NSAIDS may cause gastrointestinal discomfort or pain, or occasionally ulcers when taken chronically. Younger people seem less susceptible to these problems than adults, but still should be closely watched and have routine blood tests. These medications should be taken with food in order to minimize stomach distress. Medications that help protect the gastrointestinal tract (such as ranitidine or sucralfate) can be prescribed if needed to control symptoms.

When NSAIDs are not enough, the next stage of medications, (also known as second line medications), are sometimes called disease modifying anti-rheumatic drugs or DMARDs. This group of medications include: Sulfasalazine, Methotrexate and Corticosteroids.

The most recent and most promising medications for treating AS and related diseases are the biologics, or Tumor-Necrosis-Factor alpha (TNF-a) blockers. TNF-a is a chemical the body produces that increases inflammation and they have been shown to be highly effective in reducing or sometimes even eliminating the symptoms of AS. Most research studies of these TNF inhibitors have been done in adults, but there is every reason to believe that they will be equally as effective in young adults.

We also know that they are relatively safe medications in teens because they have been used for several years now in children and teens with other forms of arthritis. The main risk for people taking a TNF inhibitor is that they will develop a serious infection. This makes it important for doctors to screen for certain infections before starting a TNF inhibitor, and then to check blood counts frequently.

Comfort Measures

If NSAIDs and other anti-inflammatory medications are not adequate for pain relief, often times heat and/or acetaminophen can be beneficial. Stronger pain medications are only rarely needed. In addition, because younger people with back arthritis may experience muscle spasm, massage may be useful, and occasionally muscle relaxants. Acupuncture is not usually recommended for children or teens.

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