10 Ways to Prevent Long-Term Joint Damage From Ankylosing Spondylitis

Alcohol can weaken your bones, according to the Spondylitis Association of America (SAA), particularly if you have more than two drinks a day. Alcohol can also interact with medications for ankylosing spondylitis. “Alcohol can be risky with some medications for ankylosing spondylitis, and it’s also a risk factor for osteoporosis when taken to excess,” Goodman notes.

It may be okay to drink in moderation, however, even with ankylosing spondylitis, she adds. Moderate drinking is defined as up to one drink a day for women and up to two drinks a day for men, according to the National Institute on Alcohol Abuse and Alcoholism. Talk to your doctor about whether alcohol will interfere with your medication.

Even if you don’t drink to excess, ankylosing spondylitis may increase your risk for osteoporosis and bone fractures, according to the SAA. For bone health, load up on both calcium and vitamin D, which are essential nutrients that work together as a team. Calcium is needed to build and maintain bones; vitamin D helps your body absorb calcium. The Bone Health & Osteoporosis Foundation recommends 1,000 milligrams (mg) of calcium daily for women up to age 50 and men up to age 70, after which everyone should get 1,200 mg daily. Dairy products are good sources of calcium. Daily recommendations for vitamin D are 400 to 800 IU for men and women under 50, and then 800 to 1,000 IU for those over 50. Sunlight, fatty fish, fortified foods, and supplements are sources of vitamin D. “It’s very important to carefully assess bone health with a bone mineral density study, and ensure that patients are getting enough vitamin D,” Goodman says.

Exercise, particularly stretching and weight-bearing activities, can protect against joint damage, according to the SAA. It can also help prevent some of the stiffness that comes with ankylosing spondylitis. You can work with a physical therapist to determine the best type and intensity of exercise for you. For example, low-impact activities like walking and swimming are generally easier on joints than running, tennis, and soccer. Walk on a flat surface to reduce joint strain and gently stretch for better flexibility and function.

It’s especially important to minimize the risk of falling because ankylosing spondylitis often leaves the bones in the neck and back more fragile and more susceptible to fracture. To stay steady on your feet, invest in stable, secure, properly fitting footwear that has good support and cushioning to help protect your foot and ankle joints. Wearing proper shoes may also help reduce the likelihood of plantar fasciitis, a common cause of heel pain that often occurs in people with ankylosing spondylitis.

Concentrate on the alignment of your spine to alleviate pain and prevent damage. As ankylosing spondylitis progresses, it may cause permanent flexion — or forward tilting — in your neck and back. Stretching your neck, upper back, and shoulders can help maintain flexibility. Try to stretch several times throughout the day for a few minutes at a time. Also, focus on stretching your neck and standing and sitting “tall,” keeping your chin centered and parallel to the floor, the SAA recommends. You can even protect yourself when you sleep: Stick to a thin, flat pillow (or no pillow) to prevent too much flexion in your neck.

Don’t smoke, and be sure to also avoid exposure to secondhand smoke to help protect your joints. People with ankylosing spondylitis who develop syndesmophytes are more likely to have had a longer history of smoking than those who don’t, according to research. Over time, people with syndesmophytes were 3 times more likely to experience progressive joint damage in the spine.

“Smoking accelerates bone demineralization and bone loss, worsening osteoporosis,” Goodman says. “It also increases inflammation and impedes the response to therapy.” In addition, people with ankylosing spondylitis are already at increased risk for cardiovascular disease, and smoking worsens that risk, she notes.

Pilates is also recommended, as it can help strengthen your core muscles. This muscle-toning exercise plan can be a helpful complementary therapy to manage symptoms of ankylosing spondylitis. A review of research found that Pilates may help reduce pain and stiffness and lessen disability from arthritis-related conditions.

Fatigue is a common problem for people with ankylosing spondylitis. While a restful, restorative night of sleep can help both physically and mentally, lack of sleep boosts inflammation in the body, according to a research review. Sleep on a firm mattress on your stomach or back, manage pain with medications and other techniques, and keep a regular sleep-wake schedule. Avoiding caffeine and drinking more water may also lead to better sleep.

There are many tools that can help you perform daily tasks while easing the strain on your spine and protecting your joints. A shoehorn with a long handle, for example, can make it easier to slip on shoes. Extra-wide side-view mirrors on your car can make it easier for you to see without straining. (Adjust your headrest for additional support.) Raised seats or cushions can make it easier to get down and up from chairs. Work with an occupational therapist, who can recommend adaptive devices that will be most beneficial for you.

If you’re not sleeping well, aren’t able to exercise, or are in any way suffering because of your symptoms, talk with your doctor. Work together on a medication plan as well as additional lifestyle changes to preserve your joint health and function. Your doctor can also help you find emotional support by pointing you toward a support group or other resources to help you cope with the mental effects of living with ankylosing spondylitis.

Additional reporting by Brian Dunleavy