Medications for Ankylosing Spondylitis

Ankylosing spondylitis (AS) causes chronic inflammation, especially in the joints of the spine. Other joints, such as the hips, and organs may also be affected. The inflammation can cause pain, stiffness, and fatigue.¹

If left untreated, AS may progress and cause the spinal joints to fuse together. This limits a person's movement. Medicines used to treat AS help reduce inflammation, which reduces symptoms. They also may delay or prevent long-term complications.¹

The over-the-counter and prescription drugs used to treat AS include:¹

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Biologic disease-modifying antirheumatic drugs (DMARDs)
• Janus kinase (JAK) inhibitors, another type of DMARD

When these medicines do not control symptoms, your doctor may try other drugs that are not specifically approved for AS.^1,2

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are usually the first drug doctors recommend for the pain and stiffness of AS. This group of drugs works for up to 8 out of 10 people with AS. NSAIDs are generally affordable, over-the-counter drugs. Stronger prescription versions may be needed for more severe pain.¹

Examples of NSAIDs include:¹

• Aleve (naproxen)
• Celebrex, Elyxyb (celecoxib)
• Advil, Motrin IB (ibuprofen)
• Arthrotec (diclofenac, misoprostol)
• Mobic (meloxicam)
• Indocin (indomethacin)
• Voltaren (diclofenac)

The side effects of NSAIDs can be significant, especially when they are used long-term at high doses. Antacids may help with some of these issues. Side effects include:^1,2

• Upset stomach or stomach pain
• Heartburn and indigestion
• Stomach inflammation
• Ulcers and stomach bleeding
• Increased risk of heart attack or stroke

While NSAIDs work quickly on pain, their anti-inflammatory effect takes longer. People who cannot tolerate NSAIDs and people who do not get enough relief from NSAIDs have other treatment options.¹

Biologics

Biologics are drugs made in a lab using living cells. These cells may come from parts of the blood, proteins, viruses, or tissue. The cells are then made into drugs that can prevent, treat, and cure disease.³

The biologics most often prescribed for AS include:

• Tumor necrosis factor (TNF) inhibitors
• Interleukin 17-A (IL-17A) inhibitors

TNF inhibitors and Il-17A inhibitors are often a second-line treatment if NSAIDs are not bringing enough pain relief. They also may be prescribed if joint damage is visible during imaging tests.¹

You may hear these drugs called DMARDs, immunosuppressants, or immunomodulators. This means they change how the immune system works. DMARDs are used to decrease inflammation and pain, reduce joint damage, and slow disease progression. DMARDs may be biologics or synthetics.^1,4

Tumor necrosis factor (TNF) inhibitors

Examples of TNF inhibitors used for AS include:^1,2

• Cimzia® (certolizumab pegol)
• Enbrel® (etanercept)
• Humira® (adalimumab)
• Inflectra® (infliximab-dyyb)
• Remicade® (infliximab) and its biosimilar, Avsola® (infliximab-axxq)
• Renflexis® (infliximab-abda)
• Simponi® (golimumab) and Simponi Aria® (golimumab)

Interleukin 17-A (IL-17A) inhibitors

Examples of IL-17A inhibitors for AS include:^1,2

• Cosentyx® (secukinumab)
• Taltz® (ixekizumab)

Janus kinase (JAK) inhibitors

JAK inhibitors are a type of synthetic, or non-biologic, DMARD. Examples of JAK inhibitors prescribed for AS include:^1,2

• Rinvoq® (upadacitinib)
• Xeljanz® (tofacitinib citrate)

Because everyone responds differently to medications, people may need to try more than one DMARD to find what works best for them. In addition, each DMARD has unique side effects. Because DMARDs impact how the immune system works, side effects may include:^1,2

• Serious infections, including viral, bacteria, and fungal infections
• Higher risk of heart attacks and stroke
• Blood clots
• Higher risk of certain cancers

Other drugs used to treat AS

There are several other drugs doctors may use to treat AS if NSAIDs and DMARDs do not work. However, these drugs are used off-label and may or may not be helpful in treating AS. These include:^1,2

• Corticosteroids (prednisone, dexamethasone) – may help calm the inflammation of AS flares but should not be used long-term to treat AS
• Sulfasalazine (Azulfidine®) – may be prescribed for people with AS and inflammatory bowel disease (IBD)
• Methotrexate – a chemotherapy drug used to treat other autoimmune conditions, like rheumatoid arthritis

These are not all of the medicines your doctor may prescribe for your AS. Side effects can vary depending on the specific drug you are taking. Talk to your doctor about what to expect when taking medicines for AS. You also should call your doctor if you have any changes that concern you when taking any medicine.

Before beginning treatment for AS, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.