Therapy of ankylosing spondylitis--a review. Part I: Conventional medical treatment and surgical therapy.

The main outcome parameters in AS and other SpA are pain, disease activity, function, spinal mobility, and structural progression. There are several treatment options, which differ, depending on the localization and severity of the manifestation and the degree of structural changes already present. There is a basic role for physiotherapy to improve and maintain spinal mobility and function and prevent handicap. The basis for drug therapy in AS is NSAIDs, which may also have an influence on structural progression. DMARDs are mainly used in cases with peripheral arthritis. Corticosteroids have a clear role for intra-articular therapy, while the role for systemic use is, in contrast to RA, mainly reserved for subgroups. It is largely unclear whether long-term spinal progression can be prevented by conventional drug therapy. Treatment with biologics such as anti-TNF-alpha therapy is discussed in Part 2 of this review. To be published in the next issue of the Scandinavian Journal of Rheumatology. Surgical treatment of the spine is indicated in cases of severe instability pain, in cases of deformity endangering the patient in daily life by the limited range of vision, and in patients with neurological deficiency. AS-specific problems are spinal fractures and atlantoaxial instability, which need careful management including surgery. Joint replacement therapy is established and beneficial for AS-disturbed joints of the hip and knee.