Do you also start your day with back stiffness and pain as soon as you wake up in the morning? Does this pain decrease when you walk a little, do something useful, and increase again when you are still? These can be common symptoms of a disease called Ankylosing Spondylitis (AS). This is a really annoying condition that interferes with daily life. As a treatment for this, doctors first prescribe painkillers (NSAIDs). If these do not control the disease, they may refer you to injections called biologics. However, some people do not get relief from these treatments, or their side effects are difficult to tolerate. Are you experiencing the same thing? If so, do not worry. With the advancement of medical science, another new and successful treatment has now come to light. That is Janus Kinase (JAK) inhibitors . Let's talk about this today.
What are JAK Inhibitors?
JAK inhibitors are a new class of drugs for treating ankylosing spondylitis. Like biologics, they belong to a class of drugs called disease-modifying antirheumatic drugs (DMARDs). "Disease-modifying" means that these drugs don't just reduce pain. They also control damage to the spine and other joints, slowing down the progression of the disease.
But these are not just used for Ankylosing Spondylitis. This type of medication is also approved for several other autoimmune diseases. That is, diseases in which the body's immune system attacks its own cells.
- Rheumatoid arthritis
- Polyarticular course juvenile idiopathic arthritis (JIA)
- Psoriatic arthritis
- Ulcerative colitis
The special thing is that you can take these as pills instead of having to get injections like biologics. So this is a big relief for those who are afraid of injections.
What types are used for Ankylosing Spondylitis?
Currently, two types of JAK inhibitors are approved for the treatment of Ankylosing Spondylitis.
- Tofacitinib (brand name: Xeljanz, Xeljanz-XR)
- Upadacitinib (brand name: Rinvoq)
These are usually prescribed to patients whose symptoms have not been controlled with one or more biologic medications called TNF inhibitors, or who cannot tolerate the side effects of those medications. Therefore, your doctor will carefully review your complete medical history before prescribing this medication.
How does this medicine work?
To understand this, let's take a small example. Imagine that our body's immune system is a large army. In a disease like Ankylosing Spondylitis, this army gets the wrong message and starts attacking its own country's (our own body's) joints. This attack is what causes pain and swelling (inflammation).
There are some "messengers" that send these wrong messages. They are called JAK enzymes . These enzymes are the ones that signal the immune cells to "go and attack," the chemicals called cytokines.
What drugs called JAK inhibitors do is block those very messengers (JAK enzymes). This stops the flow of those wrong messages and reduces the immune system's ability to attack the joints.
Biologic drugs work a little differently. A biologic targets and blocks a specific cytokine, such as TNF or IL-17. JAK inhibitors block the production of multiple cytokines at once. Simply put, they block the problem in the first place.
Are there any side effects?
As with any medication, there is a chance of side effects. But for the majority of people, they are safe. Your doctor will monitor you closely before you start taking this medication and while you are taking it.
| Type of side effect | Description |
|---|---|
| Common (usually not serious) side effects |
|
| Rare serious side effects (Boxed Warning) |
A little more about serious side effects
Because these medications suppress the immune system, the body's ability to fight germs like bacteria and viruses is somewhat reduced. This increases the risk of infections.
Tuberculosis (TB) testing: Before starting this medication, your doctor will definitely test you for tuberculosis. Some people may have latent TB bacteria in their bodies. When you use a JAK inhibitor, this dormant bacteria can become active. Therefore, your doctor will monitor you for this during treatment.
Important: While taking this medication, you should avoid getting live vaccines. Examples include measles, mumps, rubella (MMR), and rotavirus. These vaccines can make you sick because your immune system is weakened at that time. Be sure to talk to your doctor before getting any vaccine.
What should I expect when starting medication?
Some people start to feel relief from their symptoms within as little as two weeks of starting this medication. However, it may take up to 6 months for some people to feel complete relief. This varies from person to person.
If you don't feel any better after taking medication for a few months, don't panic and talk to your doctor about it and get advice on what to do next.
Take-Home Message
- JAK inhibitors are a new class of drugs that are available as pills for ankylosing spondylitis. They are usually given to people who have failed other treatments.
- These medications not only reduce pain, but also control damage to the joints.
- These are very easy to use because they don't require injections like biologics.
- Like all medications, this one can have side effects. Therefore, it is essential to have regular blood tests under the supervision of a doctor.
- Never start, stop, or change the dosage of this medication without your doctor's advice.
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