Finding the right option for you can prevent spinal damage in the future.
A healthy lifestyle is essential for managing ankylosing spondylitis (AS), a type of arthritis that affects the spine. However, many people with AS will also need medication to reduce inflammation and prevent spinal fusion, or ankylosis. Luckily, there are many medications to treat ankylosing spondylitis.
Without treatment, AS tends to be progressive. It causes continued inflammation, worsening symptoms, and worsening spinal damage. “The treatment is critical to preventing that from happening or minimizing that,” says Anca D. Askanase, MD, MPH, rheumatologist at Columbia University Irving Medical Center. “The new therapeutic options that we have not only treat the inflammation and prevent the damage, but they also help with the symptoms.”
The Ladder to Treat Ankylosing Spondylitis
As with many conditions, AS exists on a spectrum. Your doctor will start you on the least aggressive treatment options first. This way, you can find relief with the fewest side effects or other risks. When that’s not enough, you and your doctor will work up the “treatment ladder,” trying more aggressive treatment options until you find the right fit.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are often the first-line therapy to treat ankylosing spondylitis, and many patients use only NSAIDs to find relief from symptoms. NSAIDs help reduce inflammation, thus relieving back pain and stiffness. You and your doctor will work together to find the right type of NSAID, and to find the safest and most effective dose.
Biologics are a subtype of disease-modifying anti-rheumatic drug (DMARD). Conventional DMARDs suppress the entire immune system, but biologics target more specific proteins or immune cells that cause AS activity.
While NSAIDs mostly treat symptoms, biologics and other DMARDs attack the disease at its source. “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 Dr. Askanase.
The primary biologics for AS are tumor necrosis factor (TNF) inhibitors and interleukin-17 (IL-17) inhibitors. Doctors may recommend these biologics for people who haven’t found relief from NSAIDs.
Finding the Right Treatment for You
You might be anxious to start your AS treatment and find relief, but you may need some patience. It may take two to four weeks of ongoing treatment before you notice a benefit, and you may need to try a couple different options before you find the right fit.
That said, the effort to find the right medication option for you is worth it. Starting treatment early for AS can mean the difference between a normal and active life, and one with spinal damage and limited mobility.
“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, the correct balance between exercise and medication, lifestyle changes, and therapeutic interventions,” 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.
- Ankylosing spondylitis. Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2020. (Accessed on September 29, 2020)
- Treatment of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. Waltham, MA: UpToDate, 2020. (Accessed on September 29, 2020)