You probably know that Ankylosing Spondylitis (AS) is a lifelong, somewhat debilitating condition. You know how difficult it is to get through the day with back pain and morning stiffness. But, there is good news. Although this disease cannot be completely cured, we can control its symptoms with the right medication, exercise, and a healthy lifestyle. These medications can help stop or delay the progression of back problems.
Step One: NSAIDs - for pain and swelling
When you go to the doctor, this is the first type of medication they will try to give you for this condition. We call these Nonsteroidal Anti-inflammatory Drugs, or (NSAIDs) for short. While some of these can be purchased over the counter at the pharmacy, some require a prescription from a doctor.
Simply put, these medications work by stopping the production of chemicals called prostaglandins in our bodies that cause inflammation. This reduces your pain and swelling. Taking these medications at night, especially, can help you sleep better and reduce back stiffness in the morning.
The most important thing is to take this medicine at the dosage and for the prescribed period as prescribed by your doctor . Do not stop or change the dosage at will.
| Type of medication (NSAID) | Side effects and what to know |
|---|---|
| This medicine may cause stomach upset when used for a long time. For example:
Therefore, your doctor may prescribe other medications (such as antacids) to protect your stomach along with this medication. If you have a history of heart disease, you should definitely tell your doctor. Some NSAIDs may slightly increase the risk of heart attack or stroke. |
Step two: DMARDs - disease-modifying anti-rheumatic drugs
Sometimes NSAIDs alone may not be enough to control your symptoms. If that's the case, your doctor may next prescribe you a type of medication called (DMARDs) , which stands for Disease-Modifying Antirheumatic Drugs . While the name may sound complicated, what it does is simple. It works by limiting the damage to your joints and tissues caused by inflammation. These slow down the progression of the disease.
| Type of medication (DMARD) | Things to know in particular |
|---|---|
| Sulfasalazine | This is taken as a pill. Some people may experience headaches, bloating, nausea, and mouth sores. Very rarely, bone marrow can be affected, so your doctor will often check your blood when giving you this medicine. |
| Methotrexate | This comes as a pill or as an injection that you can give yourself. You will definitely need to take a folic acid pill with this. This is to avoid side effects like mouth sores and nausea. Since this is a bit of a strong medicine, your doctor will check your blood and liver function regularly. This medicine is not suitable for pregnant women or those who are trying to get pregnant. |
Corticosteroids - quick relief for painful joints
These are a type of steroid. Your doctor can give you a steroid injection, such as ``Prednisone'', directly into your very painful, swollen joint. This will provide immediate relief from the pain and swelling.
But remember, this is not a treatment that is given to the whole body. Also, these injections cannot be given frequently. Usually, the doctor gives these injections only a few times a year, with an interval of a few months.
Biologics - the latest and most powerful treatment method
If other treatments don't work for you, your doctor may tell you about this new treatment. These are called biologics . They are made from living cells. Specifically, these medications block proteins called cytokines that trigger inflammation in our immune system. This is a targeted therapy. These come as injections. Some of them you can give yourself at home.
TNF inhibitors
These are a type of biologic often used for AS. TNF stands for a protein called ``Tumor Necrosis Factor''. These medications treat inflammation in the spine, joints, eyes, and intestines. They can also slow down the progression of AS.
- Adalimumab (Humira)
- Certolizumab pegol (Cimzia)
- Etanercept (Enbrel)
- Golimumab (Simponi)
- Infliximab (Remicade)
Interleukin (IL-17) inhibitors
If TNF inhibitors don't work, your doctor may start you on this type.
- Ixekizumab (Taltz)
- Secukinumab (Cosentyx)
Biologics are very powerful medications. That's why they have side effects to be aware of. Your doctor will explain all of this to you before you start treatment.
| Main risks and side effects of biologics | |
|---|---|
| Risk of infection | Because these medications suppress the immune system to some extent, they increase the risk of developing infections, especially tuberculosis (TB). Therefore, it is essential to get tested for TB before starting these medications. |
| Other risks | - A very slight increase in the risk of skin cancer. - Increased risk of lymphoma cancer in children. - If you already have inflammatory bowel disease (IBD), your symptoms may worsen. |
If you do not feel better after about 3 months of this treatment, your doctor will decide to stop the medication or switch you to another biologic.
Hope for future treatments
Scientists are currently working to find new drugs that can reverse AS. They are also studying how our genes affect the disease. This research could lead to more effective treatments that are specific to you in the future.
Take-Home Message
- Ankylosing Spondylitis (AS) is a lifelong condition, but it can be well controlled with the right treatment and lifestyle.
- Treatment usually starts with NSAIDs. If these do not control the condition, medications such as DMARDs or biologics are used.
- Trust your doctor. Follow his/her instructions exactly. Go to clinics on time and get tested.
- Never stop taking your medication or change the dosage on your own. If you have any concerns, talk to your doctor.
- Along with medication, proper exercise and a healthy diet are two essential things to control this disease.
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