Ankylosing Spondylitis (AS): Medications Can Maximize Quality of Life
Judi Ebbert, PhD, MPH, RN | Feb 21, 2017 March 2, 2017
Reviewed by Diane M. Horowitz, MD on July 16, 2017
What is AS?
AS is a form of arthritis that attacks the sacroiliac joint. AS can cause fusion of the vertebrae and sometimes the ribs. AS is incurable, but treatment advances can control pain and stiffness. The American College of Rheumatology’s treatment goal is to ease symptoms and preserve normal posture, flexibility, and the ability to work and enjoy life.
Who's got your back?
The American College of Rheumatology (ACR), the Spondylitis Association of America (SAA), and the SpondyloArthritis Research and Treatment Network (SPARTAN) are collaborating to advance the array of treatment options for people with AS. They are committed to ensuring the best possible quality of life for all who are diagnosed with AS.
The widening array of treatment options
Clinical research has added innovative therapies to traditional prescription and over-the-counter drugs. The AS treatment plan should blend medication with appropriate exercise. The patient and provider team should collaborate as partners to formulate an effective treatment strategy.
Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin, Celebrex, Voltaren, ibuprofen, ketorolac, naproxen and more. NSAIDs work best when combined with exercise and sometimes with another drug. NSAIDs block chemicals produced by the body that cause pain and inflammation. It’s best to take them with food to reduce risk for stomach ulcers.
Corticosteroids, like the cortisone produced by our bodies, reduce inflammation. When medication alone doesn’t provide relief from an inflammatory episode, a doctor may inject corticosteroids into painful joints. Relief is rapid but not long lasting. Corticosteroids can be injected in the sacroiliac, hip, or knee joint, but not the spine.
Disease-Modifying Antirheumatic Drugs (DMARDs)
DMARDs reduce joint damage by blocking inflammation. Traditional DMARDs work by restricting the body’s immune system. Newer DMARDs target specific pathways within immune cells. The traditional DMARD that is most often given for AS is sulfasalazine.
Biologic agents block proteins in the inflammatory response. The FDA has approved adalimumab, certolizumab, etanercept, golimumab, and infliximab. The drugs suppress the Tumor Necrosis Factor-alpha (TNF-α) protein and can relieve symptoms when other medications fail. They are given by intravenous infusion or injection.
In cases of very severe AS, surgery may be advised. Surgery for a person with AS usually is done to replace the hip joint. If the spine is severely curved, which is called kyphosis, surgery can correct the deformity, but it is rarely undertaken because the procedure carries significant risk.
What's on the horizon?
Researchers are seeking genes involved in the development of AS. Further study may yield strategies to prevent inflammatory attacks by one’s own immune system. Innovative AS treatments are being tested in clinical trials. Use the ClinicalTrials.gov tool to find trials of interest. AS drug trials are opportunities to try promising new therapies.
Embrace helpful AS resources!
It’s important to have access to current, reliable information about all aspects of AS, including new developments. The Spondylitis Association of America offers comprehensive information and interactive mechanisms for messaging and support. Connecting with others will expand your network of professionals and friends who truly have your back!