Ankylosing spondylitis (AS) is a lifelong condition that has no cure. But several types of medications may stop or delay more spinal problems and ease your pain and swelling. That -- along with exercise and a healthy diet -- would help you to move better and to keep or slow your condition from worsening.
AS is not the same as non-radiographic axial spondyloarthritis (nrAxSpA). But experts think the conditions sometimes can be two stages of the same disease. So you’ll probably get the same treatment for both.
The first thing your doctor will have you try is nonsteroidal anti-inflammatory drugs (NSAIDs). Some are sold over the counter and others are prescription only. They calm AS-related pain by stopping your body from making inflammation-causing chemicals called prostaglandins. If you take NSAIDs at night, they may help you sleep so you feel better in the morning.
NSAIDs that may help with AS include:
It may take several weeks for you to feel better. If you use NSAIDs for a long time, they may hurt your stomach. You may also get:
- Stomach inflammation
- Ulcers or bleeding
Your doctor may want you to take an antacid and other drugs to protect your stomach lining. Tell your doctor if you have a history of heart disease. NSAIDs can make you more likely to get a heart attack or stroke.
NSAIDs may not control all of your symptoms. Your doctor may also want you to take disease-modifying antirheumatic drugs (DMARDs). This group of different medications works to limit the tissue damage from inflammation.
Your doctor may prescribe:
SPEAKER: Ankylosing spondylitis
symptoms are often worse when
you haven't moved for a while
so you're probably the stiffest
in the morning,
but there are things you can do
to ease your pain
and get the day off
to the right start.
Once you're awake,
the first thing you want to do
is warm up.
Heating pads or a warm shower
can help loosen up your back.
A few simple stretches can help,
too, so try some yoga postures.
In one study, yoga was shown
to have stopped the progression
Some people with AS
have trouble fully expanding
their ribs and chest
while they breathe,
but deep breathing exercises can
help with that.
Ask a physical therapist to show
you the ropes,
or try a technique called
You inhale up
from the diaphragm, instead of
For the rest of the day,
practice good posture.
Stand tall, with shoulders back.
Tighten stomach muscles, and put
your weight on the balls
of your feet.
This will keep you
from hunching, and it may also
slow bone fusion.
Take five to 10 minute breaks
at work or school,
to stretch and move.
This will help
with your posture, flexibility,
and it may also help keep pain
You can take sulfasalazine as a pill. You may notice side effects, including headaches, stomach bloating, nausea, and mouth ulcers. It’s rare, but you could have problems with your bone marrow. That’s why your doctor may test your blood when you’re on sulfasalazine.
Methotrexate comes as a pill or as a shot you give yourself. You’ll need to take it together with folic acid to help prevent mouth sores, nausea, and other side effects. Methotrexate is a powerful drug. Your doctor will test your blood and keep an eye on your liver. You shouldn’t take methotrexate if you’re pregnant.
These drugs are a type of steroid hormone that your body makes naturally. You may get a shot of a man-made version called prednisone. This can help ease pain and swelling in specific spots. But your doctor won’t use it for your whole body. And you may be able to get shots for your inflamed joints only a few times a year, a few months apart.
If other treatments don’t work, your doctor may try a drug made from living organisms. These biologics help your immune system block proteins called cytokines responsible for inflammation. You can give yourself a shot of a biologic medication at home.
TNF inhibitors. TNF stands for tumor necrosis factor. These drugs can treat inflammation in your joints, gut, eyes, and spine. They may slow the growth of your disease. Each medicine works in a different way. If one doesn’t help, your doctor may switch you to a different one.
These five TNF inhibitors are approved by the FDA to treat AS:
Interleukin inhibitors. These are also called IL-17 inhibitors. Your doctor may want you to try them if you don’t respond to TNF inhibitors. You may get fewer side effects.
The FDA has approved two IL-17 inhibitors for AS. They are:
Biologics raise your chances for infections like tuberculous (TB). You will need a TB test before you start treatment. Other side effects include:
- Slightly higher risk of skin cancer
- Higher risk of lymphoma in children
- Higher risk of inflammatory bowel disease (IBD) or worse symptoms if you already have it
If you don’t feel better within 3 months, your doctor may stop or switch your biologic treatment.
You should feel better when you treat your inflammation. But it may take some time for you to find the right medicine. If you still hurt, ask your doctors if you should take something just for pain. They can tell you if any over-the-counter or prescription painkillers may help.
Experts are still trying to find new drugs to reverse AS. They’re also studying how your genes play a role in getting AS. This could lead to new medications. Someday, doctors may be able to give you a treatment tailored just for you.