Medications for Ankylosing Spondylitis

Many treatments can help you feel and function better with ankylosing spondylitis. These 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.

NSAIDs

Your first step to treat AS will be to take nonsteroidal anti-inflammatory drugs (NSAIDs). They 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
  • Ibuprofen
  • Indomethacin
  • Meloxicam (Mobic)
  • Naproxen

You can get most NSAIDs in generic forms. Some, like ibuprofen and naproxen, are sold over the counter in drugstores.

Unfortunately, NSAIDs can break down the barriers that protect your stomach. This can cause an upset stomach and heartburn. In time, NSAIDs can 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.

DMARDs

If NSAIDs don’t ease your AS symptoms, your doctor may prescribe stronger drugs called disease-modifying anti-rheumatic drugs (DMARDs). They affect your immune system and can help curb inflammation. They may help with the arthritis that can damage your back and other joints. They also may 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 is healthy.

Sulfasalazine is available as pills. You may have side effects like headaches, bloating, nausea, or mouth ulcers. Your doctor will test your blood from time to time to watch for side effects.

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. Your doctor can inject steroids into the joints, including your sacroiliac (where your lower back meets your pelvis), knee, or hip joint. While these can help, you don’t want to rely on them as your main treatment.

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Biologics

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

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

You have a higher chance of getting 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 odds of getting certain types of cancer, but this is rare.

Biologic drugs used to treat AS include:

Future Treatments

There is research going on now to find new treatments for AS. Some studies focus on genes, including HLA-B27, that make you more likely to get the disease. Others focus on proteins that may trigger inflammation. Researchers hope to come up with new drugs to stop AS before it can damage your back and other joints.

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 Tyler Wheeler, MD on December 14, 2018

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.”

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