Medications and Drugs

There are a number of different types of medications that have been found to be effective in managing the symptoms of ankylosing spondylitis and related diseases. Note that different people respond to different medications with varying levels of effectiveness. Thus, it may take time to find the most effective medication for treating someone with spondylitis.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are the most commonly used class of medication used in treating the pain and stiffness associated with spondyloarthritis. For example, Ibuprofen is a generic NSAID and is found in over-the-counter pain relievers such as Advil and Motrin. They commonly come in tablet form and are taken orally.

Sometimes high doses of NSAIDs are needed to maintain relief from the symptoms of ankylosing spondylitis and related diseases. This can pose a problem in that NSAIDs can cause significant side effects, especially in the gastrointestinal tract (stomach, intestines, etc.) NSAIDs can cause reduction in the protective mucus in the stomach, which can cause stomach irritation. In time, this can lead to heartburn, gastritis as well as ulcers and even bleeding. People can take other medications (such as antacids) to neutralize or prevent the production of excess stomach acid, take drugs to help coat and protect the stomach (such as Carafate), or take medication to help restore the lost mucus (such as Cytotec).

A different class of NSAIDs known as COX-2 inhibitors (or COXIBs) allegedly reduce the risk of gastrointestinal complications associated with traditional NSAID therapy. Celebrex (Celecoxib) is still being used to treat spondyloarthritis. Others, such as Vioxx, were pulled from the market because of potential cardiac side effects.

When NSAIDs Are Not Enough?

Although NSAIDs are commonly the first line of medications used to treat ankylosing spondylitis and related diseases, sometimes they aren’t enough to control the symptoms. It is important to note, however, that it may take several weeks for some NSAIDs to show positive results. If you are considering changing medications, remember to ask your doctor about the potential benefits and side effects before you and your doctor decide whether the change in treatment is right for you.

In severe cases of ankylosing spondylitis or related disease, NSAIDs may only be partially effective or the side effects too severe to continue their use. In this case, a doctor may prescribe one of the following medications.

  • Sulfasalazine is one type of medication that can be helpful to some people with severe disease. It is known to effectively control not only pain and joint swelling from arthritis of the small joints, but also the intestinal lesions in inflammatory bowel disease. It comes in tablet form and is taken orally.

    Side effects are relatively infrequent, but can include headaches, abdominal bloating, nausea and oral ulcers. Rarely, someone being prescribed this medication can develop bone marrow suppression, which is why it is important for your doctor to regularly monitor your blood count.

  • Originally developed to treat cancer, this chemotherapy drug is widely used and often very effective for the treatment of rheumatoid arthritis. When prescribed for treating ankylosing spondylitis, it is given in much smaller doses. Methotrexate can either be taken via a self-injectable shot, or orally in tablet form. When taking methotrexate, it is also necessary to take the vitamin folic acid in order to help suppress possible side effects.

    Oral ulcers and nausea are the most common side effects, but can be minimized by taking folic acid. Because of other potential serious side effects, the frequent monitoring of blood counts and liver tests are required.

  • Corticosteroids such as prednisone can be effective in relieving the inflammation of AS, but the side effects of long-term use can be very severe. Corticosteroid injections into the inflamed joints can provide temporary relief of the pain caused by arthritis or bursitis. In instances of Achilles' tendonitis, such injections are rarely, if ever used because of the risk of rupturing the Achilles tendon. Also, the usefulness of corticosteroid injections to relieve the symptoms of plantar fasciitis (heel pain) is not clear.

  • The Tumor-Necrosis-Factor alpha (TNF-a) blockers are biologic medications that have shown great promise in treating ankylosing spondylitis. They have been shown to be highly effective in treating not only the arthritis of the joints but the spinal arthritis associated with ankylosing spondylitis and related diseases.

    The most serious known side effect of the TNF blockers is an increased frequency of infections, especially tuberculosis. Thus, a TB test is usually required before starting any of the TNF therapies. A very rare possible complication is increased frequency of cancer, especially of the blood (leukemia) or of the lymphatic system (lymphoma).

    It should be noted that each TNF-α Inhibitor / Biologic medications works in a slightly different manner. Thus, if one does not have a positive effect, another one might.