• DMARDs, preferably sulfasalazine, may be given along with NSAIDs to slow or stop the progression of the disease in patients with predominant peripheral arthritis.

• Glucocorticoid injections can be given in particularly painful and swollen joints that did not respond with other therapies. Systemic corticosteroids should be avoided if possible.

• TNF inhibitors are indicated in patients who have active disease in the spine and do not respond to NSAIDs and nonbiologic DMARDs.

• Exercise and prevention methods include a program of active, range-of-motion exercises for the spine, hips, and shoulders as well as deep-breathing exercises, abundant rest, especially early in the disease, use of a firm mattress on a bed board and a firm armchair with a high seat, and application of heat. As the disease activity lessens, medications may be decreased and possibly discontinued, but exercises should be continued to maintain range of motion.

• Joint replacement surgery is indicated for pain and functional disability not responsive to medical therapy. Hip replacement is most common and may cause severe pain and incapacitation, which is relieved by total hip replacement. Hip involvement can occur early in the ankylosing spondylitis disease process.

• Physical therapy with supervised exercises that are land or water based should be recommended. Physical therapy is not believed to prevent progression of the disease, but it may minimize the symptoms in some patients.