DMARDs treat inflammation at the source.
Many people with ankylosing spondylitis (AS) will find relief from their symptoms with over-the-counter pain relievers like ibuprofen. However, some people with AS need more advanced treatment options. For example, one advanced treatment option that may help certain people with AS is a category called DMARDs: disease-modifying antirheumatic drugs.
“DMARDs … are medications that treat the inflammation at a profound level, to the level of stopping that inflammation and preventing the damage that comes from the ongoing unquenched inflammation,” says Anca D. Askanase, MD, MPH, rheumatologist at Columbia University Irving Medical Center.
How DMARDs Work
DMARDs can help treat a number of inflammatory arthritis conditions. Technically, this class of medications started as a treatment for rheumatoid arthritis, but they have since expanded to help treat others as well, such as psoriatic arthritis and occasionally ankylosing spondylitis.
Some DMARDs suppress the entire immune system to keep it from attacking the joints. These are not typically used for AS. One exception is if you have joint pain in your peripheral joints (e.g., hands, feet, knees), in addition to your spinal pain.
However, a subtype of DMARDs called biologics is more commonly used for the advanced treatment of AS. Biologics are more targeted and block the specific cells or proteins that fuel the immune attacks on the joints. The most common biologics for AS are tumor necrosis factor (TNF) inhibitors and interleukin-17 inhibitors.
The Benefit of DMARDs
While nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help with symptoms, DMARDs can target the disease at its source: the immune system.
“Disease-modifying means changing the course of the disease, slowing it down or stopping it from progressing,” says Dr. Askanase. “The benefit [of DMARDs] is to prevent some [of the] joint damage that comes from unquenched inflammation, ultimately maintaining function and allowing for normal life.”
If you are having trouble managing your AS symptoms, DMARDs may help by:
- Reducing symptoms of inflammation
- Preventing ankylosing spondylitis flares
- Slowing the progression of the disease
- Preventing complications like spinal fusion
- Preserving mobility and range of motion
- Improving quality of life
Remember: Not everyone with AS is a candidate for biologics and other DMARDs. For this reason, you should talk to your doctor to learn all your options. “You and your doctor are a team. It’s a partnership. You need to work together to find the correct treatment that works for you,” says Dr. Askanase.
Dr. Askanase is a rheumatologist specializing in lupus, Sjogren's syndrome, and vasculitis at Columbia University Irving Medical Center. She is the founder and clinical director of Columbia's Lupus Center and the Director of Rheumatology Clinical Trials.
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