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. Click on the image to the right for a quick list. The listing comes from our book, Straight Talk On Spondylitis, which also has a detailed section on medications.
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.
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.
AZULFIDINE (Sulfasalazine)
Patient Information
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. More information on corticosteroids can be found at Medline Plus.
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).
There are Patient Assistance Programs available to help pay for the TNF blockers:
Patient Assistance Programs
Although the TNF-a inhibitors have shown very promising results in some people with AS, not everyone has access to them. There are programs that may be able to help.
- The Patient Access Network Foundation - From the site: "The Patient Access Network Foundation is a non-profit 501(c)(3) organization dedicated to supporting the needs of patients that cannot access the treatments they need due to out-of-pocket health care costs."
- Partnership for Prescription Assistance - From the site: "The Partnership for Prescription Assistance brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that’s right for them."
- Enliven: Enbrel Patient Assistance Program - From the site: "Enliven Services offers free information and assistance designed specifically for people who use ENBREL."
- Remicade Patient Assistance Program - Remicade was recently approved by the FDA to treat AS.
- Chronic Disease Fund - Their focus is to provide assistance to those under-insured patients who are diagnosed with chronic or life altering diseases that require the use of expensive, specialty therapeutics.
- RxHope - From the site: RxHope is the only patient assistance Internet initiative financially supported by PhRMA (Pharmaceutical and Research Manufacturers of America) and participating pharmaceutical companies.
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