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:
- Celecoxib (Celebrex)
- Diclofenac/Misoprostol (Arthrotec)
- Ibuprofen (Advil)
- Indomethacin (Tivorbex)
- Meloxicam (Mobic)
- Naproxen (Aleve)
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:
- Methotrexate (Otrexup, Rasuvo, Trexall, Rheumatrex)
- Sulfasalazine (Azulfidine)
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:
- Adalimumab (Humira)
- Certolizumab pegol (Cimzia)
- Etanercept (Enbrel)
- Golimumab (Simponi)
- Infliximab (Remicade)
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:
- Ixekizumab (Taltz)
- Secukinumab (Cosentyx)
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.