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Are you struggling with back pain and stiffness from ankylosing spondylitis? If so, the right medications can make a huge difference in controlling your symptoms and protecting your joints long term.
Learn about medications for ankylosing spondylitis, including NSAIDs, biologics, DMARDs, and lifestyle tips to manage symptoms effectively.
Key Takeaways
- NSAIDs are the first-line treatment for ankylosing spondylitis.
- Biologic treatments (TNF and IL-17 inhibitors) are the most effective for severe cases.
- DMARDs and JAK inhibitors are additional options if biologics fail or are not tolerated.
- Early and consistent treatment prevents joint damage and disability.
- Combining medication with lifestyle changes yields the best long-term results.
Summary
- Ankylosing spondylitis (AS) is an inflammatory arthritis affecting the spine, causing pain, stiffness, and potential vertebrae fusion.
- Early treatment is crucial to prevent permanent joint damage and disability.
- NSAIDs are the first-line treatment to reduce inflammation and pain for mild to moderate AS symptoms.
- Biologic medications, such as TNF inhibitors and IL-17 inhibitors, are highly effective for severe AS and prevent disease progression.
- TNF inhibitors include Humira, Enbrel, Remicade, Cimzia, and Simponi and work by blocking TNF-alpha protein.
- IL-17 inhibitors like Cosentyx and Taltz are alternatives for patients who do not respond to TNF inhibitors.
- Other options include DMARDs and JAK inhibitors, which may be used if biologics are ineffective or not tolerated.
- Medications carry risks such as infection and organ-related side effects, requiring monitoring.
- Natural treatments like exercise, anti-inflammatory diets, and supplements can complement medication.
- Consistent treatment and early diagnosis improve quality of life and reduce complications like heart disease.
Full Transcript — Download SRT & Markdown
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But with so many options out there, how do you know which one is right for you?
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Let's break it down. Hello, this is Dr. Siddharth Tambar from Chicago Arthritis and Regenerative Medicine.
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I specialize in non-surgical treatments for musculoskeletal conditions, rheumatology, regenerative medicine, and metabolic health. My goal is to help you live pain-free and optimize your health with cutting-edge treatments.
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Today we're talking about ankylosing spondylitis or AS, specifically the medication that can help you manage this condition.
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If you or a loved one has AS, stick around to learn how these treatments work, their benefits, and what you need to watch out for.
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Ankylosing spondylitis is a type of inflammatory arthritis that primarily affects the spine. It causes chronic pain, stiffness, and in some cases, fusion of the vertebrae, making movement difficult.
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Why is it important to treat AS early? Without treatment, AS can lead to permanent joint damage and disability.
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Medications can reduce inflammation, relieve pain, and slow down progression. The right treatment can help you stay active, mobile, and improve your quality of life.
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So let's go over the main types of medications used. The first-line treatment for ankylosing spondylitis has traditionally been NSAIDs or non-steroidal anti-inflammatory medications.
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These are the first-line treatments for decades. They include medications like ibuprofen, Advil, Motrin, Naproxen, Aleve, Naprosyn, and Indomethacin.
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How do they work? They reduce inflammation and pain. They can help to improve your flexibility and mobility.
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The pros are that they're easily accessible and affordable. They're effective for mild to moderate symptoms as well.
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The cons or the drawbacks are that long-term use can cause stomach ulcers, liver, and kidney issues.
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They may not be enough for severe inflammation. And if NSAIDs alone don't control the disease, we move on to the next level of treatment.
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If NSAIDs aren't enough, the current standard of care is to move on to biologic medications as the next step.
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These are designed to block specific parts of the immune system that drive inflammation, and they do a dramatically better job of controlling inflammation in the spine than any other treatments that we have available.
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TNF inhibitors are tumor necrosis factor inhibitors. These are the most commonly used biologic medications for AS.
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Examples include Humira, Enbrel, Remicade, Cimzia, and Simponi. How do they work? They block TNF-alpha, a protein that triggers inflammation in AS. This dramatically reduces pain, stiffness, and prevents disease progression.
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The pros are they're highly effective for reducing inflammation. They're the gold standard of treatment for AS, and they help to prevent long-term joint damage.
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The cons are that they can increase the risk of infections. They do require regular injections or IV infusions over time and long term.
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And if you don't have insurance, it can be expensive, but hopefully your physician is able to actually source low-cost or free treatments if needed.
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The next type of biologic treatment to be aware of are IL-17 or interleukin-17 inhibitors.
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For some patients, TNF inhibitors may not work. That's where IL-17 inhibitors come in. These include treatments such as Cosentyx and Taltz.
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How do they work? They block IL-17, another key protein involved in AS inflammation. The pros are that they work well in patients who don't respond well to TNF inhibitors.
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The cons are they can also increase the risk of infections. And again, they are expensive as well.
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If biologic medications are not an option or if the disease remains uncontrolled, we can consider additional treatment options.
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Other treatment options include DMARDs and JAK inhibitors. DMARDs or disease-modifying anti-rheumatic drugs. Common ones include sulfasalazine and methotrexate.
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These are more effective for peripheral arthritis in your joints and your arms and your legs.
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They're not quite as helpful for spinal ankylosing spondylitis, but it's an option. JAK inhibitors or Janus kinase inhibitors are newer oral medications.
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Like Xeljanz and Rinvoq, they work by blocking signals that cause inflammation. These options may be used if biologics do not work or are not tolerated.
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Potential issues with DMARDs and JAK inhibitors include infection risk as well, as well as you need to keep an eye on your liver and cell count abnormalities.
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Some common questions that I hear about AS medications include the following question. One is how long does it take for AS medications to work?
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If you're taking something mild, like an NSAID and over-the-counter NSAID, they can work within hours to days.
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Biologics, on the other hand, may take weeks to months to show full effects. Question two is, are there natural treatments that help alongside medication?
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Absolutely. You should be doing exercise and stretching to keep your spine flexible. An anti-inflammatory diet, rich in omega-3s and low in processed foods can also help.
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Supplements like turmeric, fish oil, and vitamin D may provide additional benefits as well. Next question is, what if I don't actually treat my AS?
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Is that a problem? The thing is untreated AS can lead to progressive disease and progressive damage leading to spinal fusion, making it much harder to move, leading to higher rates of disability, as well as inability to do the activities you actually want to do in life.
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The newer treatments prevent that from happening. In addition, uncontrolled inflammation in AS can also increase the risk of heart disease and other complications.
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The key, as always in rheumatology, is early diagnosis and early and consistent treatment. Some key takeaways here.
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NSAIDs are the first-line treatment for AS. Biologic treatments like TNF blockers and IL-17 inhibitors are the most effective for severe cases.
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And other options like DMARDs and JAK inhibitors may be used if needed as well.
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Combining medication with lifestyle changes gives the best long-term results. If you or someone you know has AS, talk to a rheumatologist to find the best treatment plan.
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If you found this helpful, make sure to like, subscribe, and hit the notification bell so you don't miss future videos on arthritis or regenerative medicine and staying pain-free.
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For more expert advice, visit ChicagoArthritis.com to schedule a consultation. Stay healthy, stay active, and I'll see you in the next video.
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And as always, live well.
Topics:ankylosing spondylitisAS medicationsNSAIDsbiologic treatmentsTNF inhibitorsIL-17 inhibitorsDMARDsJAK inhibitorsinflammatory arthritisrheumatology
