Ankylosing Spondylitis Treatments: 8 Medicines and Therapies That May Help

Ankylosing spondylitis (AS) is a literal pain in the back. Over time, this inflammatory condition can cause vertebrae in the spine to fuse. It often begins presenting itself in early adulthood—though, per Johns Hopkins Medicine, less than 1% of the US population has it, making it quite rare.

For those who have ankylosing spondylitis, early treatment is key for keeping the condition from getting worse and letting you move well for as long as possible.

How is ankylosing spondylitis treated?

There's no cure, per se, for ankylosing spondylitis, says the National Institute of Arthritis and Musculoskeletal and Skin Diseases. That said, there are treatment options for easing pain, managing symptoms, and slowing the progression of the disease.

NSAIDs

The first line of defense for a new ankylosing spondylitis patient is non-steroidal anti-inflammatory drugs (NSAIDs). "A low dose anti-inflammatory is very common for patients to take in early years of ankylosing spondylitis," explains Anand Veeravagu, MD, assistant professor of neurosurgery and director of minimally invasive neurospine surgery at Stanford Medicine.

These medicines reduce the pain of ankylosing spondylitis with minimal side effects, which is why they're often the first medication for new patients. But ankylosing spondylitis is also a progressive disease, which means it's likely to get worse over time, although how much worse depends on the patient.

NSAIDs may also be helpful in this regard, too. "There's some evidence that they may decrease the risk of the further progression of the radiographic findings, of the bones fusing together," says Nick Shamie, MD, chief of orthopedic spine surgery and professor of orthopedic surgery and neurosurgery at UCLA School of Medicine. However, there's some disagreement between studies on this point, he says.

NSAIDs can be purchased over-the-counter, such as naproxen, but generally, doctors will prescribe a clinical-strength version for ankylosing spondylitis patients, such as indomethacin. The Spondylitis Association of America (SAA) says side effects for NSAIDs include gastrointestinal issues like heartburn, gastritis, and even ulcers or bleeding. Other medicines, like antacids, are sometimes recommended to help protect the stomach.

TNF Inhibitors

When pain isn't kept under control with NSAIDs, the disease continues to get worse, or other joints in the body are inflamed, doctors turn to more specific medications, Dr. Veeravagu tells Health.

Tumor necrosis factor (TNF) inhibitors (a class of biologic medicines) keep your body from producing an inflammatory trigger called TNF-alpha protein. In healthy people, the body naturally blocks excess TNF, whereas people with ankylosing spondylitis often have more in their blood than necessary, explains the American College of Rheumatology.

The SAA says these TNF inhibitors are currently approved for treating ankylosing spondylitis:

• infliximab (Remicade)
• adalimumab (Humira)
• etanercept (Enbrel)
• golimumab (Simponi)
• certolizumab pegol (Cimzia)

These drugs are often prescribed based on whether you have other conditions that may interact poorly with them, says Dr. Veeravagu. If one doesn't work for you, talk with your doctor, as another version may be more helpful.

However, there's a reason doctors don't start early-stage patients off with TNF inhibitors. "The more advanced treatments come with more side effects," Dr. Shamie tells Health. Side-effects from TNF inhibitors include skin reactions at the injection site, as well as an increased risk of infections and a harder time fighting infections. They may also increase the risk of certain cancers, like skin cancer.

IL-17 inhibitors

Another type of biologic, called an IL-17 inhibitor, also works by tamping down inflammation in the body. These drugs may be an option for people who respond poorly to TNF inhibitors or cannot tolerate them, says the SAA.

There are two FDA-approved IL-17 inhibitors for people with ankylosing spondylitis:

• secukinumab (Cosentyx)
• ixekizumab (Taltz)

Like the TNF inhibitors, these drugs pose an increased risk of infections, and they can make it more difficult to fight off infections. IL-17 inhibitors have also been shown to worsen or bring on new cases of inflammatory bowel disease.

Physical therapy

Beyond pain management, another major goal for ankylosing spondylitis patients is preventing a "catastrophic injury," says Dr. Veeravagu. Because the spine can fuse together, it becomes less forgiving, and people with AS are at a higher risk of spinal fracture and spinal cord injury should they fall.

Physical therapy can help preserve movement, balance, and stability. "We think about a physical therapy plan that focuses on strengthening the core, lower extremities, and the pelvis to support the spine," says Dr. Veeravagu.

The goal is to avoid irritating the painful and stiff joints, like the sacroiliac joint, while preserving range of motion and strength in the joints that have to compensate in order to move well.

Corticosteroids

Corticosteroids may be prescribed for patients having a flare, but they're intended for short-term use.

"Steroids have a negative effect on metabolism, they can cause your blood sugar to go up, and they can weaken your tissues and bones. So if you take it long term, it can have really serious side effects," Dr. Shamie explains.

Still, steroids can be a very powerful anti-inflammatory, which is why they are sometimes prescribed to help with an acute ankylosing spondylitis flare—for example, after an injury.

Disease-modifying antirheumatic drugs (DMARDs)

If you know other people with arthritic conditions, you may have heard of DMARDs. These drugs, like methotrexate and sulfasalazine, are effective at treating peripheral joint pain—think knees or ankles.

They are frequently effective and well-tolerated by people with AS who develop arthritis in these peripheral joints, per Johns Hopkins Medicine.

Complementary treatment

This category includes therapies that have not been proven via rigorous scientific studies to benefit people with ankylosing spondylitis. Still, the SAA says some people with AS have found them helpful. They include:

• chiropractic treatment
• acupuncture
• yoga
• therapeutic massage
• transcutaneous electrical nerve stimulation

Be sure to consult your doctor before beginning any of these treatments.

Surgery

Most people with AS don't get surgery, but it may be an option in certain cases. Depending on your situation, your doctor may suggest joint repair or replacement, says NIAMS.