Medications for Ankylosing Spondylitis
Ankylosing spondylitis (AS) causes a chronic inflammation in the body, primarily in the joints of the spine, although other joints and other organs in the body can also be affected. The joint inflammation can cause pain and stiffness, and if the disease progresses unchecked, the joints may fuse together, limiting mobility and rotation. Medications used to treat AS aim to reduce the inflammation, reduce the symptoms of AS, and delay or prevent structural damage and possible complications of the disease. The medications used in treatment of AS can be grouped into the following categories:
NSAIDs are some of the oldest and most widely used medications for pain and inflammation and are widely used as a first-line treatment for AS. Some NSAIDs are available over-the-counter, although higher strength NSAIDs, which may be needed to relieve the pain and inflammation of AS, are only available with a prescription. While NSAIDs work quickly on pain, their effect as an anti-inflammatory takes longer. NSAIDs can cause significant side effects, including stomach or intestinal irritation, and some people may not be able to tolerate them.1,2
Biologic medications are usually a second-line therapy, used after treatment with NSAIDs has been tried, and they are typically used in people with AS who have evidence of joint damage visible on imaging (radiographic axial spondylitis).3 Biologic medications are made from living organisms and are designed to target specific aspects of the inflammatory process, such as tumor necrosis factor (TNF)6 and interleukin 17-A (IL-17A).4
There are 2 IL-17A blocker used to treat AS: Cosentyx® (secukinumab) and Taltz® (Ixekizumab). There are several TNF inhibitors, including:
Because each person responds differently to medications, an individual may need to try more than one biologic to find what works best for them. In addition, each biologic has its own side effect and safety profile, and some people may not be able to tolerate certain medications. Because biologic medications target certain proteins involved in the immune system function, common side effects of biologics include infections, which may be serious.
Corticosteroids, also called glucocorticoids or steroids, mimic the body’s natural hormone of cortisol. They come in different forms (oral, injection, and infusions) and may be used in certain people with AS to reduce inflammation and pain. For AS, it is recommended that corticosteroids only be used for short-term treatment, such as a flare of AS in peripheral joints, flares during pregnancy, or flares that occur alongside flares of inflammatory bowel disease.3,5
SAARDs/DMARDs are drugs which reduce inflammation and have typically been used to treat inflammatory arthritis conditions like AS, rheumatoid arthritis, and psoriatic arthritis. They are less commonly used with the availability and effectiveness of biologic medications, although they may be used in certain cases when patients cannot tolerate or take biologics.