Nonsteroidal anti-inflammatory drugs (NSAIDs)The most common type of medicine used to treat ankylosing spondylitis is nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs help reduce the pain and swelling of the joints and decrease stiffness. However, they do not prevent further joint damage. Two common NSAIDS are Aspirin® and Advil®.
NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher dose. NSAIDs such as ASA (Aspirin, Anacin, etc.) and ibuprofen (Motrin IB, Advil, etc.) can be purchased without a prescription. Examples of other NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril. The various NSAIDs and Aspirin®, if taken in full doses, usually have the same levels of anti-inflammatory effect. However, different individuals may experience greater relief from one medication than another. Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers and bleeding. People taking these medications should consider taking something to protect the stomach, such as misoprostol (Cytotec).
Disease-modifying anti-rheumatic drugs (DMARDs) For those with severe disease who have inflamed joints, a drug called sulfasalazine can help manage the symptoms, and better control the disease. Sulfasalazine is one type of a family of medicines called disease-modifying anti-rheumatic drugs (DMARDs).
DMARDs try to stop AS from getting worse. DMARDS take about two to six months before they begin to make a difference in the pain and swelling.
Disease modifying anti-rheumatic drugs (DMARDs) are often prescribed to relieve severe symptoms of ankylosing spondylitis. These medications are designed to prevent AS from getting worse, but do not reverse permanent joint damage. It will usually take several months for DMARDs to make a noticeable improvement in the inflammation.
The most common DMARDs are methotrexate and sulfasalazine. DMARDs are often given along with other medications such as NSAIDs. Common side effects of DMARDs are mouth sores, diarrhea and nausea. These drugs may have effects on pain or swelling in hands or feet but have not been shown to be effective in inflammation in the spine. More serious side effects, monitored through regular blood and urine tests, include liver damage, and excessive lowering of white blood cell count (increasing susceptibility to certain infections), and platelet count (affecting blood clotting).
Corticosteroids Occasionally a cortisone injection into an affected joint or ligament brings short-term relief. Cortisone is a steroid that reduces inflammation and swelling.
For severe pain and inflammation, doctors can inject a powerful anti-inflammatory drug, called a corticosteroid, directly into the affected joint. Cortisone is a steroid that reduces inflammation and swelling. It is a hormone naturally produced by the body. Corticosteroids are man-made drugs that closely resemble cortisone. An injection can provide almost immediate relief for a tender, swollen, and inflamed joint. However, this treatment can only be used periodically because excess corticosteroids can weaken the cartilage and bone.
• If your eyes are affected, cortisone eye drops may also be prescribed.
Biologic Response Modifiers (Biologics) Biologics are newer drugs that are becoming available for AS patients that fail to respond to conventional treatment. These drugs block specific hormones which are involved in the inflammatory process.
The newest medical option for treating AS is a class of drugs called biological response modifiers (BRMs), or biologics. Biologics are DMARDs that are made up of genetically modified proteins. They work by blocking specific parts of the immune system, called cytokines, which play a role in ankylosing spondylitis. The most commonly used biologics block one of two important cytokines, either tumor necrosis factor (TNF) or interleukin-1 (IL-1). Biologics are often used to treat rheumatoid arthritis, and recently have been shown to have the potential to slow or even halt the progression of AS in some people. Unlike the other DMARDs, they have been shown to effectively treat the spinal arthritis also associated with AS, as well as the arthritis of the joints of the hands or feet. These drugs work quickly to ease inflammation and can be used in combination with other medications, such as DMARDs.
Depending on the biologic prescribed, they are either given by injection at home or by an intravenous infusion at a clinic. Side effects occasionally seen with these medications include mild skin reactions at the injection site, headaches or dizziness, colds or sinus infections, and nausea or diarrhea. Your doctor will discuss all of the other side effects of these medications before he or she prescribes them.
Biologics currently available include Enbrel®, Humira® and Remicade®. At the time of publication, both, Enbrel® and Remicade® have received approval for the indication of ankylosing spondylitis, specifically. Your physician will explain the differences between these medications should he or she prescribe a biologic for AS.
What else should I know about Biologics? PrecautionBiologics work by suppressing your immune system which can make it slightly harder for you to fight off infections. Please inform your doctor if you are prone to frequentinfections. It is advisable to stop your medication and call your doctor if you develop a fever or if you have or think you have an infection. Before starting biologics, your doctor should check for other infections, such as tuberculosis.
CostBiologic treatments are costly, and can range anywhere from $15,000 to $25,000 per year. Depending on the type of insurance coverage you have, treatments may be fully covered or you may be required to share the cost.
