An Overview of Ankylosing Spondylitis Treatment
Key takeaways:
Medications are an important part of the treatment of ankylosing spondylitis. They can improve symptoms and prevent joint and spine damage.
First-choice treatment is usually nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. But most people need an additional medication — like a biologic — to feel their best.
There is no single best medication for ankylosing spondylitis because everyone responds to therapy differently. The best treatment is the one that works for you.
Table of contents
Ankylosing spondylitis is a rare kind of autoimmune arthritis that causes pain and stiffness in the spine and joints. It is different from osteoarthritis, which is due to the wear and tear of aging.
In ankylosing spondylitis, the immune system behaves like a broken faucet, causing a flood of inflammation throughout the body. Ankylosing spondylitis medications turn off this faucet. They improve symptoms and protect the body from further damage down the line.
What’s the first-line treatment for ankylosing spondylitis?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-choice treatment for ankylosing spondylitis. In most cases, NSAIDs are usually taken as needed. But for ankylosing spondylitis, they are taken daily to stay ahead of pain and inflammation.
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Many NSAIDs are available over-the-counter (OTC). But higher, prescription-strength doses are needed to treat ankylosing spondylitis. Common examples of NSAIDs are:
It’s important to point out that physical therapy, exercise, and other non-medication therapies are also first-choice for ankylosing spondylitis. Medications work best when combined with other self-care measures.
What medications can treat ankylosing spondylitis?
There are a lot of treatment options for ankylosing spondylitis. But everyone responds to treatments differently, so there’s no one-size-fits-all approach. The best treatment is the one that works best for you. It can take time to find that treatment, but rest assured: You have options.
NSAIDs
As mentioned above, NSAIDs are the first choice for treatment. But most people with ankylosing spondylitis will also need one of the medications listed below to feel their best. If you’ve been taking NSAIDs regularly for 2 months without improvement, it’s time to add another medication.
NSAIDs may not be a safe option for certain people. For example, people with chronic kidney disease or a history of stomach bleeding should avoid these medications. Talk to your healthcare provider about whether NSAIDs are a safe choice for you.
DMARDs
Disease-modifying antirheumatic drugs (DMARDs) help treat inflammation in the joints and tendons — but not the spine or sacroiliac joints. They take about 6 to 8 weeks to start working, with full effect around 3 to 6 months. They may be combined with NSAIDs, biologics, or Jak inhibitors.
Examples include:
Sulfasalazine (Azulfidine): This is a great option for people with tendon inflammation, or people who are pregnant or trying to become pregnant.
Methotrexate: This is a good option for joint inflammation.
Leflunomide (Arava): This is a good option for people who experience side effects with methotrexate.
Biologics
When spinal or sacroiliac joint pain doesn’t get better with NSAIDs, biologics are the next best step. Several different biologics are available to treat ankylosing spondylitis. They each block a specific molecule, which is like turning off a different “faucet” (piece of the immune system) in an effort to stop the flood of inflammation. They’re injected or infused into the vein, and they take about 3 to 6 months to kick in. They may be used in combination with DMARDs and/or NSAIDs.
These biologics block a molecule called TNF-alpha:
Humira (injection)
Enbrel (injection)
Cimzia (injection)
Simponi (injection) and Simponi Aria (infusion)
Remicade (infusion)
These biologics block a molecule called IL-17:
Of note, biosimilars for many of these medications are also available. These are like generic versions of biologics, and they may be less expensive. Pharmaceutical companies expect to develop more of them in the future.
Jak inhibitors
Jak inhibitors are oral medications that treat inflammation in the spine. They can be a good option for some people with ankylosing spondylitis. They take about 6 to 8 weeks to kick in. Like biologics, they may be used in combination with DMARDs and/or NSAIDs.
Examples include:
Jak inhibitors are not the safest choice for people with a history of blood clots, cancer, or certain types of heart disease. Together with your healthcare provider, you’ll determine what’s best for you.
Are there surgeries that can help ankylosing spondylitis?
Surgery doesn’t stop the flood of inflammation that causes symptoms or damage in ankylosing spondylitis. But fortunately, the goal of the above medications is to stop the flood of inflammation before surgery is ever needed.
If many years of ankylosing spondylitis have caused permanent joint damage or disability, surgery may help. For example, hip or knee replacement surgery may help if arthritis severely limits the ability to walk or stand.
Spine surgery for ankylosing spondylitis is far less common because of the risks involved. If necessary, it should be done by a spine surgeon with specific expertise in caring for people with ankylosing spondylitis.
How can you treat ankylosing spondylitis naturally?
Medications are necessary when it comes to treating ankylosing spondylitis. But they’re not the whole story. Self-care is important too. There’s a lot you can do to feel your best. In addition to taking your medications, you can:
Exercise and stretch.
Eat a healthy diet (like the Mediterranean diet).
Get enough sleep.
Limit stress.
Try physical therapy.
The bottom line
Ankylosing spondylitis is a chronic condition, but it’s treatable. Medications can improve your symptoms and protect your joints and spine from damage down the line. There are many different treatment options, and scientists are discovering more every year. Together with your healthcare provider, you’ll find the medication that works best for you.
Why trust our experts?
References
Arthritis Foundation. (n.d.). DMARDs.
Ward, M. M., et al. (2019). 2019 Update of the American College of Rheumatology / Spondylitis Association of America / Spondyloarthritis Research and Treatment Network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis and Rheumatology.
