Therapy of the spondyloarthropathies.

The key to successful therapy for patients with ankylosing spondylitis is a lifelong, carefully devised, and well-instructed exercise program. This program is designed to maintain maximum range of motion within the spine, and the costovertebral and girdle joints, thereby preventing the tendency to flexion contractures and loss of height. The exercise program frequency requires long-term concomitant therapy with nonsteroidal anti-inflammatory drugs, partly to relieve the painful perispinal muscle spasm which frequently inhibits the exercise movements. The drugs are not known to alter the natural history of the inflammatory lesion. Local measures directed at ocular, urethral, and mucocutaneous inflammation may be symptomatically beneficial. These simple therapeutic principles ensure a good functional prognosis in the vast majority of patients with spondylitis.