What Is Remission?
While there is currently no cure for ankylosing spondylitis, the ultimate goal is to remain in remission for as long as possible. Remission is a period of time during which your ankylosing spondylitis symptoms subside. You may experience a low level of disease activity, with little inflammation or physical limitation caused by joint pain and stiffness. “We want to get each person with ankylosing spondylitis to a place where he or she can maintain remission and possibly lower the use of medications,” says Anca Askanase, MD, an associate professor of medicine and director of rheumatology clinical trials at Columbia University Medical Center in New York City. With ankylosing spondylitis, simply a lack of physical symptoms such as muscle and joint stiffness and pain isn’t enough for a doctor to declare a person to be in remission. “A person’s bloodwork needs to come back showing that the inflammation is gone as well,” Dr. Askanase says. While remission is possible with ankylosing spondylitis, it’s not common. When you’re in a period of remission, your doctor may lower your medication dosage or reduce how often you need to take your medication. “It’s about determining if the person can discontinue the medications and remain in remission without them,” Askanase says. Unfortunately, people in remission who stop medications may need to start them again due to a flare. “Even if the symptoms disappear, the inflammation may still be present,” Askanase says. “And if inflammation goes unmanaged, it could result in slow, irreversible damage to the joints.”
How to Achieve Remission
Following your treatment plan is the best way to relieve ankylosing spondylitis symptoms like joint pain and stiffness and increase your chance of achieving remission. Medications used to treat ankylosing spondylitis include nonsteroidal anti-inflammatory drugs (NSAIDs); disease-modifying anti-rheumatic drugs called biologics, which target the immune system, such as tumor necrosis factor (TNF) blockers or interleukin 17 (IL-17) inhibitors; methotrexate; and sulfasalazine. In addition to taking your medication, Askanase recommends following a healthy lifestyle, including eating a healthy, well-balanced diet, to help remain in remission. The Spondylitis Association of America (SAA) recommends eating a variety of fruits, vegetables, and whole grains, and minimizing your intake of processed foods. Dredge has adopted an anti-inflammatory diet, which avoids consumption of nightshades, a variety of primarily flowering foods such as tomatoes, potatoes, bell peppers, and more. Per her rheumatologist’s recommendation, she’s also going to start, for the short term, the keto diet, a high fat, low carbohydrate diet. Askanase also recommends people with ankylosing spondylitis get regular exercise. According to the SAA, exercise is one of the most effective ways to relieve the symptoms of ankylosing spondylitis. Exercise guidelines from the Centers for Disease Control and Prevention say that adults should do moderate-intensity aerobic exercise for at least 150 minutes a week, as well as strength training exercises on at least two days a week. Low-impact activities that combine mobility, strength training, and function training may be especially beneficial for people with ankylosing spondylitis, says the SAA. Askanase often refers people with ankylosing spondylitis to physical therapy to help relieve muscle and joint stiffness. At Carolina Sports Clinic in Charlotte, NC, Joshua Kollmann, team chiropractor for the NFL’s Carolina Panthers, sees two to three people with ankylosing spondylitis each week. Kollmann works with his team of physical therapists and often a person’s rheumatologist to develop a plan of care to help alleviate his or her symptoms.
What to Do If Symptoms Return
It’s likely that your ankylosing spondylitis symptoms may flare up again following a period of remission. If this happens, talk to your doctor about the best ways to manage and treat your symptoms. When Dredge’s symptoms returned with a vengeance, she immediately contacted her rheumatologist, who prescribed anti-inflammatory medications as well as biologics. Although Dredge isn’t currently in remission, it’s always her goal with ankylosing spondylitis. “One day I’d love to have no symptoms at all,” she says.
