Medications for Ankylosing Spondylitis

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Cindy Kuzma

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Scientists haven’t yet developed a cure for ankylosing spondylitis. But prescription and over-the-counter (OTC) medications can do a lot to control your symptoms and ease pain. Some medicines even slow down or stop your disease from progressing. Here’s a rundown of the most common drug treatments.


Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Available over the counter or by prescription, NSAIDs deal ankylosing spondylitis a double blow. Not only do they ease pain quickly, but they also help long-term by battling inflammation, the biologic pathways in your body that cause arthritis.

NSAIDs help more Americans cope with ankylosing spondylitis than any other type of drug. Specific types include:

  • Celecoxib (Celebrex)

  • Ibuprofen (Advil, Motrin)

  • Indomethacin (Indo-Lemmon)

  • Naproxen (Aleve, Anaprox)

These medicines work by interfering in the process by which your body normally produces prostaglandins. These are chemicals that contribute to pain and swelling. Low doses kill pain, while higher doses—often available only by prescription—are necessary to fight inflammation. Each type of NSAID has a slightly different effect on your body. Your health care provider will carefully consider this when recommending or prescribing them.
Side effects from NSAIDs include stomach problems, high blood pressure, heart and kidney problems, and rashes. Talk with your health care provider if you experience these effects, or if you have other conditions that might increase your risk of developing them. These include hepatitis, Crohn’s disease or other gastrointestinal conditions, asthma, or allergies to medicine.

Disease-Modifying Antirheumatic Drugs (DMARDs)

Sometimes, NSAIDs alone lack sufficient power to control ankylosing spondylitis. Your health care provider may prescribe disease-modifying antirheumatic drugs, or DMARDs.

These medicines work in a slightly different way to relieve symptoms and prevent damage to your joints. Two DMARDs are most commonly prescribed for ankylosing spondylitis:

  • Methotrexate (Rheumatrex). Smaller doses of this drug, originally developed to treat cancer, may prevent some cases of ankylosing spondylitis from progressing. You’ll need to take folic acid to prevent side effects. These can include mouth sores and nausea. Your health care provider will also check your blood frequently for signs of liver problems.

  • Sulfasalazine (Azulfidine). This medication controls both joint conditions and inflammatory bowel disease, which often occurs alongside ankylosing spondylitis.

Biologics

If your ankylosing spondylitis doesn’t respond to NSAIDs or DMARDS, your health care provider may turn to biologics. Scientists create these medicines in a lab, using living organisms. The goal is to mimic your body’s natural disease-fighting processes.

The U.S. Food and Drug Administration (FDA) has approved six types of biologics to treat ankylosing spondylitis:

  • Adalimumab (Humira)

  • Etanercept (Enbrel)

  • Golimumab (Simponi)

  • Infliximab (Remicade)
  • Certolizumab (Cimzia)
  • Secukinumab (Cosentyx)

The first five work by blocking the same inflammatory compound, called tumor necrosis factor-alpha (TNF-a); they're known as TNF inhibitors. The newest addition, secukinumab (Cosentyx), blocks a different inflammatory compound, called interleukin-17a (IL-17a); this first-of-its-kind IL 17 inhibitor is a promising option for patients who didn't find success with TNF inhibitors. You get a biologic drug either through an injection or an intravenous infusion. These medications are newer and show much promise for relieving pain and inflammation in the joints and spines of people with ankylosing spondylitis.

Like all drugs, biologics do have downsides. People taking them have a much higher risk for dangerous infections, including tuberculosis (TB). Your health care provider will probably test you for TB before starting your prescription. While taking a biologic, avoid live vaccines.

Corticosteroids

Like the cortisone your body naturally produces, these medicines control inflammation. However, because they are so strong and have severe side effects, your health care provider usually won’t recommend taking them for long-term use.

Instead, you’re more likely to receive a shot of corticosteroids directly in your painful, inflamed joint. You can get these shots where your spine meets your pelvis (sacroiliac joint ), hip joint, or knee joint, but not directly into your spine. Relief comes quickly but may not last very long.

Key Takeaways

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) ease pain quickly and also help long-term by battling inflammation.

  • Your health care provider may prescribe disease-modifying antirheumatic drugs (DMARDs), which work in a slightly different way to relieve symptoms and prevent joint damage.

  • Biologics mimic your body’s natural disease-fighting processes and show much promise. They’re given via injection or intravenous infusion.

  • You may also receive a shot of corticosteroids directly into your painful, inflamed joint.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Jan 21, 2018

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Medical References

  1. Biologics Overview. Arthritis Foundation. http://www.arthritis.org/living-with-arthritis/treatments/medication/drug-types/biologics/drug-guide...
  2. Questions and Answers about Ankylosing Spondylitis. National Institutes of Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Ankylosing_Spondylitis/default.asp
  3. Indomethacin. MedlinePlus, U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a681027.html
  4. Naproxen. MedlinePlus, U.S. National Library of Medicine. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a681029.html
  5. Ibuprofen. MedlinePlus, U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682159.html
  6. NSAIDs (nonsteroidal anti-inflammatory drugs). American College of Rheumatology. http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/NSAIDs
  7. Ankylosing Spondylitis. Spondylitis Association of America. https://www.spondylitis.org/Learn-About-Spondyloarthritis/Ankylosing-Spondylitis
  8. Medications Used to Treat Ankylosing Spondylitis and Related Diseases. Spondylitis Association of America. https://www.spondylitis.org/Learn-About-Spondyloarthritis/Medications

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