You probably know that Ankylosing Spondylitis (AS) is a very painful condition that causes pain and stiffness in the spine and joints. When treating this, it is very important to exercise and use the medication prescribed by your doctor correctly. However, sometimes these medications can cause minor side effects. But don't be afraid of them. Not everyone gets these side effects, and each person's experience is different. The most important thing is to talk to your doctor and choose the treatment method that works best for you and has the fewest side effects.
First-line painkillers: NSAIDs
Doctors often prescribe this type of medication first for AS. We call these Nonsteroidal Anti-inflammatory Drugs, or NSAIDs for short. These work to reduce swelling and pain in the joints. You may have heard of these names:
- Ibuprofen (Advil, Motrin)
- Naproxen (Naprosyn)
- Indomethacin (Indocin, Tivorbex)
- Celecoxib (Celebrex)
However, when these medications are taken in high doses for a long time, the protective mucus layer inside our stomach can become thin, which can lead to some side effects.
| Possible side effects of NSAIDs |
|---|
| Heartburn |
| Inflammation of stomach lining |
| Stomach ulcers and bleeding |
| If you have pre-existing heart disease, your risk of heart attack or stroke is increased. |
The most important thing is to use this medicine only in the dose and for the duration prescribed by your doctor. If you feel any stomach upset, tell your doctor immediately.
A modern treatment method: Biologics (IL-17 Inhibitors)
These are a slightly more advanced, specialized type of medication. They work by targeting a specific chemical in the body that causes inflammation and blocking its action. Secukinumab (Cosentyx) and Ixekizumab (Taltz) are two of these types of medications. They are called IL-17 inhibitors . Although these are very effective treatments, they can cause some side effects.
| Possible side effects of biologics | Simply put... |
|---|---|
| Inflammatory Bowel Disease (IBD) | This medication may cause new onset of IBD or worsen symptoms in someone who already has it. |
| Infections | These can reduce the function of the immune system to some extent, which may slightly increase the risk of developing infections such as colds and flu. |
| Cancer risk | Although animal studies have shown a risk of cancer, it is not yet clear what this risk is in humans. Don't be unnecessarily alarmed by this, but talk to your doctor about it. |
JAK inhibitors taken as pills
This is another class of drugs that reduce inflammation. Tofacitinib (Xeljanz) is one of these drugs that is taken as a pill. These can have side effects.
- Headache
- Diarrhea
- Fatigue
- Heart palpitations
- Risk of liver damage
Therefore, your doctor will regularly check your health while you are taking this medication.
Corticosteroids, which are only given occasionally
These are not usually long-term medications for AS. However, if you have a flare-up of pain and swelling in a particular joint, your doctor may decide to give you a corticosteroid injection just for that joint. These are more likely to cause side effects when you use them for a long time. However, short-term injections won't do all of these things. But it's good to know.
| Possible side effects of corticosteroids (especially with long-term use) | |
|---|---|
| Increased appetite and weight gain | Bruising easily |
| Mood changes | Muscle weakness |
| Blurred vision | Decreased ability to fight infections |
| Facial swelling or acne | High blood pressure |
| Diabetes or worsening of existing diabetes | Insomnia |
Other medications (Sulfasalazine and Methotrexate)
Sulfasalazine
If NSAIDs don't control your joint pain (especially in your shoulders, arms, and legs), your doctor may prescribe a medication called Sulfasalazine (Azulfidine). This has very rare side effects.
- Joint pain
- Fever
- Headache
- Increased skin sensitivity to sunlight
- Skin rash or itching
- Nausea
Methotrexate
This medicine can be taken as a pill or as an injection. The doctor will definitely recommend taking a folic acid vitamin while taking this. The reason for this is that the side effects of Methotrexate can be greatly reduced by folic acid.
- Nausea and vomiting
- Mouth ulcers
- Headache
- Feeling tired
What to do if these side effects occur?
This is the most important part. If you experience any changes in your body, new symptoms, or discomfort due to a medication you are taking for AS, the first and best thing you should do is to inform your doctor immediately.
Never stop taking your medication or change the dosage on your own. Doing so may make it harder to control your condition.
Your doctor will help you. He may:
- The dose of medicine you are given will be reduced slightly .
- You will be switched to another medication .
- Along with the current medication, another medication will be given to control the side effects .
The point here is for you and your doctor to work together as a team to find the best treatment that works for your body, with the least side effects, and with the least risk. So don't be afraid of anything, and talk to your doctor about everything openly.
Take-Home Message
- Not all medications for Ankylosing Spondylitis (AS) cause side effects, and not everyone will experience side effects.
- Being aware of side effects is one of the best steps to managing them.
- If you experience any discomfort due to your medication, never make decisions alone, and always talk to your doctor.
- Your doctor's goal is to find the treatment that works best for you and has the fewest side effects.
- It is very important to attend clinics on time and regularly discuss your condition with your doctor.
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