Many people who have ankylosing spondylitis take medications to help reduce the inflammation that causes pain and stiffness. What type of medication a doctor recommends will depend on the person’s symptoms and their severity.
There are four types of medications commonly used to treat ankylosing spondylitis: Nonsteroidal anti-inflammatory drugs (NSAIDs), biologics, steroids, and DMARDs. Like all medications, these drugs can cause side effects or interact with other medications. Patients are advised to discuss any drug therapy plan with their health care professional and report side effects.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are often the first line of defense against ankylosing spondylitis pain. NSAIDs is a broad category of medications that includes:
- Over the counter NSAIDs, such as aspirin, ibuprofen, and naproxen.
- Prescriptions NSAIDs, which have the same ingredients as over-counter-medications but are packaged in stronger doses.
- COX-2 inhibitors, sometimes called coxibs, which are available only by prescription. Celecoxib, sold as Celebrex, is a COX-2 inhibitor.
Biologic medications suppress immune system activity, thereby decreasing ankylosing spondylitis disease activity and symptoms. In some people, biologic drugs called TNF-inhibitors (TNF-blockers) as well as certain interleukin (IL) inhibitors appear to do one or more of the following:
- Slow the progression of the ankylosing spondylitis
- Treat peripheral joint pain
- Treat spinal arthritis pain
Biologic medications are administered with a needle, either injected under the skin or infused into a vein. Exactly how much and how often a medication must be administered varies significantly depending on the drug and the patient. Some ankylosing spondylitis patients may take medication once a week, while others get an infusion once every 6 weeks.
Currently, there are six FDA-approved biologic medications for ankylosing spondylitis:
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Adalimumab (Humira)
- Golimumab (Simponi)
- Certolizumab (Cimzia)
- Secukinumab (Cosentyx)
These biologic medications are expensive. In addition, they carry potential risks and side effects, including possible infections resulting from a suppressed immune system.
Researchers are studying a class of drugs called Janus kinase (JAK) inhibitors, which can be taken orally. In 2016, the FDA approved the JAK inhibitor tofacitinib citrate (XelJanz) for rheumatoid arthritis. Some experts believe it may also be effective in treating other autoimmune diseases, including as ankylosing spondylitis.
Steroids may be used to control painful eye symptoms or injected into painful joints. Oral steroids, such as oral prednisone, are rarely used to treatment AS or other spondyloarthropathies.
Disease-modifying antirheumatic drugs (DMARDs)
DMARDs, such as methotrexate and sulfasalazine, may be prescribed to people whose ankylosing spondylitis causes peripheral joint pain, such as pain in the knees, hips or ankles. DMARDs are not effective in treating pain doctors call axial joint pain, including pain in the neck, back, and sacroiliac joint.1
DMARD side effects may include but are not limited to headaches, abdominal bloating, and nausea/vomiting. Patients can develop bone marrow suppression and/or liver toxicity, so it is important for doctors to regularly monitor patient’s blood samples.
Medications May Change Over Time
Most newly-diagnosed patients are started on NSAID medications. If symptoms are not alleviated within a reasonable window of time, or if the case is severe, the doctor may recommend using another type of medication, usually a biologic. Over months or years, a medication may become less effective or cause unacceptable side effects, and a new medication can be prescribed.