Do you sometimes wake up in the morning feeling stiff and stiff? Is it hard to bend for a while? This could be due to Ankylosing Spondylitis , a condition that affects the joints of the spine. If you've tried over-the-counter pain relievers ( NSAIDs ) and the pain and swelling haven't subsided, your doctor may recommend a DMARD. So let's get to the bottom of this.
What are DMARDs and how do they work?
In Ankylosing Spondylitis, our body's defense system, the immune system , becomes overactive and starts attacking our own spinal joints. This causes inflammation , pain, and stiffness that makes it difficult to move the spine properly.
DMARD is an abbreviation for 'Disease-Modifying Antirheumatic Drug' . Simply put, it means 'arthritis medication that changes disease'. These medications work by calming down the overactive immune system. Unlike regular painkillers (NSAIDs), these not only reduce pain, but also help control the progression of the disease and prevent further damage to the joints. That's why they're called "disease-modifying" drugs.
What types of DMARDs are given for Ankylosing Spondylitis?
DMARDs given for this disease can be divided into several main categories. They are called biologics and traditional DMARDs. Let's take a look at each of these types.
| Drug type | A short description |
|---|---|
| Biologics (e.g. TNF inhibitors, IL-17 inhibitors) | They work by targeting specific proteins that cause inflammation in the immune system. These are given by injection or intravenous infusion. |
| JAK inhibitors | This is also a new type of DMARD. These are not biologics. They work by targeting a group of enzymes that cause inflammation. They can be taken as pills. |
| Traditional DMARDs (e.g. Methotrexate, Sulfasalazine) | These are mostly used for arthritis of the peripheral joints, such as the hands, feet, hips, and knees. They are less effective for arthritis of the spine. |
Biologics: Drugs that work on the same target
Biologics are like snipers. They target and attack only the proteins that directly cause the problem.
- TNF inhibitors: These are the first class of biologic drugs approved for ankylosing spondylitis. They work by blocking a protein called Tumor Necrosis Factor (TNF), which causes inflammation. They can help with arthritis of the spine and other joints, as well as conditions that can occur with the disease, such as uveitis , an inflammation of the eye, and Inflammatory Bowel Disease (IBD) ( Crohn's disease and ulcerative colitis). Your doctor will usually prescribe these if you have tried at least two types of pain relievers (NSAIDs) and haven't had any effect.
- Adalimumab (Humira)
- Certolizumab (Cimzia)
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Golimumab (Simponi)
Imagine, one TNF inhibitor didn't work for you. Don't worry. The doctor can switch you to another drug in the same class. Then there's a good chance that you'll get results.
- IL-17 inhibitors: These work by blocking another inflammatory protein called Interleukin-17 (IL-17). They are a good option for people who have not responded to TNF inhibitors or who cannot take TNF inhibitors due to conditions such as heart disease or multiple sclerosis (MS).
- Ixekizumab (Taltz)
- Secukinumab (Cosentyx)
JAK inhibitors: New drugs that can be taken as pills
These are different from biologics. They are a good solution for someone who doesn't like injections, because they come in pill form. They work by targeting an enzyme system called Janus Kinase (JAK), which causes inflammation.
- Tofacitinib (Xeljanz)
- Upadacitinib (Rinvoq)
Traditional DMARDs: The most commonly used drugs for peripheral joints
These are mainly given for pain and swelling in joints such as the hands, feet, hips, and knees, rather than pain in the spine.
- Methotrexate: This comes as a pill or injection. It helps prevent damage to the joints.
- Sulfasalazine (Azulfidine): This is also a treatment for peripheral joints and IBD. It is taken as a pill.
How does a doctor choose the right DMARD for you?
Your doctor considers several factors when choosing a medication.
- How severe your symptoms are.
- The medications you have used in the past and the results you have received from them.
- The side effects of the medication in question and how they affect your health.
What are the side effects of this medication?
Like all medications, DMARDs can have side effects. Some are minor, while others can be serious. So talk to your doctor about these before starting the medication.
- Biologics and JAK inhibitors: These slow down the immune system, making it less able to fight infections. Therefore, it is important to make sure you are up to date with all your vaccinations before starting these medications.
- Tuberculosis (TB) Test: It is essential to be tested for tuberculosis (TB) before starting TNF inhibitors, as these medications can reactivate dormant TB germs in your body.
- Other side effects: Redness at the injection site, headache, and skin rash may occur. IL-17 inhibitors may sometimes worsen IBD.
Side effects of traditional DMARDs
- Methotrexate: Stomach upset, mouth sores, and low blood cell counts can cause infections, fever, and bruising. To reduce these, your doctor will give you folic acid tablets. While taking this medication , you will need to have blood tests every 1-3 months to check your kidney and liver function. This medication is not recommended during pregnancy.
- Sulfasalazine: Nausea, vomiting, sensitivity to sunlight, skin rashes, and headaches may occur. This medication may turn your urine, sweat, and tears a yellow-orange color. It is not dangerous, but it can stain clothes.
The most important thing is to not panic if you experience any side effects and to inform your doctor immediately.
What to expect when starting treatment?
These medications do not work the same for everyone. It can take a few weeks or a month or two to see results. So it's important to be patient. Don't suddenly stop taking the medication because you think it's not working.
Also, even if your symptoms have completely subsided, it is very important to continue taking your medication for as long as your doctor tells you to. If you stop, the disease may flare up again.
Take-Home Message
- DMARDs are not like regular painkillers. In addition to reducing pain, they also control the progression of the disease and prevent joint damage.
- There are different types of drugs, such as biologics, JAK inhibitors, and traditional DMARDs. Your doctor will choose the drug that best suits your condition.
- Because these drugs suppress the immune system, there is a risk of infection. It is imperative to be tested for tuberculosis (TB) before starting TNF inhibitors.
- It takes time to see results, so be patient with your treatment. Even if your symptoms subside, do not stop taking the medication without your doctor's advice.
- If you experience any side effects or have any problems, talk to your doctor immediately.
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