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»Medications and Drugs for Ankylosing Spondylitis There are several types of medications that have proven effective in managing the symptoms of ankylosing spondylitis and related conditions. As part of ankylosing spondylitis treatment, it is important to understand that each individual responds differently to medications, with varying levels of effectiveness. Finding the most suitable treatment approach for someone with spondylitis may take time and careful adjustment under medical guidance.
NSAIDs are the most commonly used class of medication used in treating the pain and stiffness associated with spondyloarthritis. For example, ibuprofen is a generic NSAID and is found in over-the-counter pain relievers such as Advil and Motrin. They commonly come in tablet form and are taken orally.
Sometimes high doses of NSAIDs are needed to maintain relief from the symptoms of ankylosing spondylitis and related diseases. This can pose a problem in that NSAIDs can cause significant side effects, especially in the gastrointestinal tract (stomach, intestines, etc.) NSAIDs can cause reduction in the protective mucus in the stomach, which can cause stomach irritation. In time, this can lead to heartburn and gastritis as well as ulcers and even bleeding. People can take other medications (such as antacids) to neutralize or prevent the production of excess stomach acid, take drugs to help coat and protect the stomach (such as Carafate), or take medication to help restore the lost mucus (such as Cytotec).
A different class of NSAIDs known as COX-2 inhibitors (or COXIBs) allegedly reduce the risk of gastrointestinal complications associated with traditional NSAID therapy. Celebrex (Celecoxib) is still being used to treat spondyloarthritis. Others, such as Vioxx, were pulled from the market because of potential cardiac side effects.
Although NSAIDs are commonly the first line of medications used to treat ankylosing spondylitis and related diseases, sometimes they aren’t enough to control the symptoms. It is important to note, however, that it may take several weeks for some NSAIDs to show positive results. If you are considering changing medications, remember to ask your doctor about the potential benefits and side effects before you and your doctor decide whether the change in treatment is right for you.
In severe cases of ankylosing spondylitis or related disease, NSAIDs may only be partially effective or the side effects too severe to continue their use. In this case, a doctor may prescribe one of the following medications.
Sulfasalazine is one type of medication that can be helpful to some people with severe disease. It is known to effectively control not only pain and joint swelling from arthritis of the small joints, but also the intestinal lesions in inflammatory bowel disease. It comes in tablet form and is taken orally.
Side effects are relatively infrequent, but can include headaches, abdominal bloating, nausea and oral ulcers. Rarely, someone being prescribed this medication can develop bone marrow suppression, which is why it is important for your doctor to regularly monitor your blood count.
Methotrexate is widely used for autoimmune arthritis, including psoriatic arthritis treatment, although its effectiveness in ankylosing spondylitis varies. It is taken either orally or by injection in much smaller doses than those used for cancer therapy. Folic acid supplements are required to reduce side effects like nausea or mouth sores.
Oral ulcers and nausea are the most common side effects, but can be minimized by taking folic acid. Because of other potential serious side effects, the frequent monitoring of blood counts and liver tests are required.
Corticosteroids such as prednisone can be effective in relieving the inflammation of AS, but the side effects of long-term use can be very severe. Corticosteroid injections into the inflamed joints can provide temporary relief of the pain caused by arthritis or bursitis. In instances of Achilles’ tendonitis, such injections are rarely, if ever used because of the risk of rupturing the Achilles tendon. Also, the usefulness of corticosteroid injections to relieve the symptoms of plantar fasciitis (heel pain) is not clear.
Tumor Necrosis Factor-alpha (TNF-α) blockers are biologic medications that have shown significant effectiveness in the management of ankylosing spondylitis. TNF inhibitors for ankylosing spondylitis help reduce inflammation and are highly effective in treating both peripheral joint arthritis and spinal involvement associated with ankylosing spondylitis and related inflammatory diseases.
The most serious known side effect of the TNF blockers is an increased frequency of infections, especially tuberculosis. Thus, a TB test is usually required before starting any of the TNF therapies. A very rare possible complication is increased frequency of cancer, especially of the blood (leukemia) or of the lymphatic system (lymphoma).
It should be noted that each TNF-α Inhibitor / Biologic medications works in a slightly different manner. Thus, if one does not have a positive effect, another one might.
Medication choices for AS continue to evolve. A strong understanding of treatment options, combined with proper ankylosing spondylitis patient education and guidance from healthcare professionals, helps patients make informed decisions. Whether you’re managing AS, exploring treating psoriatic arthritis, or navigating reactive arthritis risk factors, working closely with your doctor ensures the safest and most effective long-term approach.