Treatments for Ankylosing Spondylitis

There are many treatments that can help you feel and function better with ankylosing spondylitis. These treatments include medications to help ease pain and inflammation and surgeries to help you move better. Your goal is to manage your AS so you can live an active life.

Medications to Fight Pain: NSAIDS

Your first step to treat AS will be taking drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs help relieve your inflammation, pain, stiffness, and swelling. Still, NSAIDs do not treat the problems with your immune system when you have AS. These problems cause damage to your joints and bones.

NSAIDs used to treat AS pain and stiffness include:

  • Celecoxib (Celebrex)
  • Diclofenac (Cataflam, Voltaren-XR, Zorvolex)
  • Ibuprofen ( Advil, Motrin)
  • Indomethacin (Indocin)
  • Meloxicam (Mobic)
  • Naproxen (Aleve, Naprosyn)

Most NSAIDs are available in generic forms. Some, like ibuprofen and naproxen, are available over the counter in drugstores.

Unfortunately, NSAIDs can increase your risk for heart attack or stroke. They can also break down the barriers that protect your stomach. This can cause an upset stomach and heartburn. In time, NSAIDs can even cause ulcers even if you don’t have symptoms. Your doctor may prescribe another medicine to protect your stomach. Celecoxib is an NSAID that may ease inflammation without hurting your stomach.

Drugs to Stop Damage: DMARDs

If NSAIDs do not ease your AS symptoms, your doctor may prescribe stronger drugs called disease-modifying anti-rheumatic drugs (DMARDs). These drugs change your immune system to curb inflammation. They may help slow your disease to delay damage to your back and other joints. They may also ease symptoms like joint pain and swelling. DMARDs don’t work very well for inflammation in the spine.

DMARDs used to treat AS include:

  • Methotrexate
  • Sulfasalazine (Azulfidine)

Methotrexate comes in both pills and shots you can give yourself at home. You may take folic acid supplements to help ease side effects like mouth sores or nausea. Methotrexate can affect your liver, so your doctor will test your blood to make sure your liver remains healthy.

Sulfasalazine is available in pill form. You may have side effects like headaches, bloating, nausea, or mouth ulcers. Your doctor will test your blood periodically to watch for side effects.

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Medication to Tame a Flare: Corticosteroids

If you have severe inflammation in a joint (called a flare), your doctor may give you a shot of corticosteroid in that spot. These drugs are also called steroids.

A steroid shot may give you short-term relief from pain and swelling in your joint, but these are given infrequently because they require radiologic guidance. Your doctor can inject steroids in your joints, including your sacroiliac (where your lower back meets your pelvis), knee, or hip joints. While these can help, you don’t want to rely on them as your main treatment.

Other Medications to Stop Inflammation and Save Your Joints: Biologics

If NSAIDs or DMARDs do not control your AS, your doctor may prescribe drugs called biologics. These drugs aim to address the problems with your immune system. They target your body’s production of specific proteins that cause inflammation.

Biologic drugs slow your immune system to help ease AS symptoms (pain, swelling, tenderness, and stiffness) as well as inflammation. These drugs may also help protect your joints from damage.

You are at higher risk of infections like tuberculosis when you take biologics. If you have signs of an infection, such as a fever or congestion, you should tell your doctor. Your doctor will test you for tuberculosis before you start a biologic drug and while you take it. These drugs also may raise your risk of getting certain types of cancer, but this is rare.

Biologic drugs used to treat AS include:

  • Adalimumab (Humira)
  • Adalimumab-atto (Amjevita), a biosimilar to Humira
  • Certolizumab (Cimzia)
  • Etanercept (Enbrel)
  • Etanercept-szzs (Ereizi), a biosimilar to Enbrel
  • Golimumab (Simponi)
  • Infliximab (Remicade)
  • Infliximab-dyyb (Inflectra), a biosimilar to Remicade
  • Secukinimab (Cosentyx)

 

Surgery

Inflammation may damage your joints over time. If the damage is severe, surgery may help.

Joint replacement. Total joint replacement or arthroplasty surgery may help give you movement again in your knees or hips. Your surgeon removes the damaged joint. Then he will replace it with a metal, plastic, or ceramic artificial joint.

Future Treatments

There is research going on now to find new treatments for AS. Some studies focus on genes, including HLA-B27, that raise your risk for getting the disease. Others focus on proteins that may trigger inflammation. Researchers hope to develop new drugs to stop AS before it can damage your back and other joints.

Alternative Treatments

In addition to what your doctor suggests, you may want to try complementary or alternative treatments for your AS pain and stiffness. Some people find treatments like massage, yoga, acupuncture, and transcutaneous electrical nerve stimulation (TENS) helpful. Talk to your doctor before you try any of these.

Pain Medications

Treating the causes of your AS inflammation should help ease your pain. Talk with your doctor about specific pain medications, back stretches, and posture exercises.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on December 6/, 016

Sources

SOURCES:

National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Questions and Answers About Ankylosing Spondylitis.”

Spondylitis Association of America: “Medications Used to Treat Ankylosing Spondylitis and Related Diseases.”

Sieper, J. Annals of the Rheumatic Diseases, Published online 2009.

Spondylitis Association of America: “Alternative Treatments.”

Harvard Medical School Patient Education Center: “Ankylosing Spondylitis.”

Arthritis Society of Canada: “Ankylosing Spondylitis.”

FDA. “FDA approves Inflectra, a biosimilar to Remicade." “FDA approves Amjevita, a biosimilar to Humira.”

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