Keeping in mind the unique manner in which Ankylosing Spondylitis progresses (bone destruction, followed by new bone formation and fusion),[1] therapy should aim to treat pain and inflammation (which destroys the bone) as well as inhibit new bone formation.[2]
Oral medications and injectables are available to treat Ankylosing Spondylitis.[3][4][5]
Discuss the right therapy options with your doctor. Together you can make an informed choice on the best treatment option for you based on your symptoms and co-morbidities.
Partner with your Rheumatologist to make a treatment decision best suited for you
Making a treatment decision is an important step in your ability to manage your condition. It is important that you are aware about the various therapy options available, based on which you can structure a conversation with your Rheumatologist and plan a treatment strategy that works best for you.
Here’s a guide to help you navigate the therapies available to manage Ankylosing Spondylitis along with a few conversation starters to help you on your journey to Fight The Fuse!
Therapeutic management of Ankylosing Spondylitis consists of 3 main drug classes:
- Non-steriodal anti-inflammatory drugs (NSAIDs)
- Disease modifying anti-rheumatic drugs (DMARDs)
- Biologics
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
This is the first treatment option for Ankylosing Spondylitis. Your Rheumatologist may prescribe a single NSAID or a combination with other medications to manage your symptoms of pain, inflammation and stiffness.[3]
Questions to Ask Your Rheumatologist
Disease modifying anti-rheumatic drugs (DMARDs)
These are medications used to treat non-axial spondyloarthritis i.e. when pain and inflammation are experienced in joints other than the spine, like hips, ankles, knees or arms.[2][7][8]
Biologics
These are innovations of medical science. They are medications manufactured within a living system i.e. they are genetically engineered proteins which are designed to block certain aspects of the immune system.[5]
Know your biologics[4][5][6]
Biologics are medicines that decrease the symptoms of Ankylosing Spondylitis by targeting or blocking certain aspects of your body’s immune activity. They work by reducing abnormal inflammation in the body and will help you:
- Manage pain and stiffness in the spine and other joints.
- Slow down the progression of Ankylosing Spondylitis.
Your Rheumatologist may initiate biologics if your symptoms are not relieved by non-steroidal anti-inflammatory drugs (NSAIDs) alone.[7]
Biologics are administered with a needle i.e., they can be injected under the skin (called sub-cutaneous injections) or infused into a vein.
It is important that you adhere to the dose and the frequency of medication that is prescribed by your Rheumatologists for maximum benefits.
Your Rheumatologist may decide to initiate biologic therapy if:[5]
- You have tried NSAIDs but you feel they are not helping you.
- You are unable to take NSAIDs due to their undesirable side effects.
- You have high levels of pain and stiffness even after taking maximum doses of NSAIDs.
- Your symptoms are having a big impact on your life and you are unable to manage daily activities.
Partner with your Rheumatologist to make the right choice on which biologic will suit you the best based on the following factors:
- Current disease activity (your symptoms).
- History of any previous illness (e.g., Tuberculosis/Inflammatory bowel disease etc.).
- Route of administration.
- Treatment goals and expectations (current symptom relief/ preventing disease progression/both).
- Side effects.
Other treatment options
Steroids: These are drugs which work very well on inflammation and are sometimes used in Ankylosing Spondylitis as well. They are usually injections which have to be directly injected into the joints. Corticosteroids are known to have many side effects and have to be used with caution. Discuss the pro’s and con’s of corticosteroid therapy with your doctor prior to initiation.[7]
Discuss the right therapy options with your Rheumatologist.
Choose an option that works to control your symptoms and Fight The Fuse!
To control the debilitating symptoms of Ankylosing Spondylitis and prevent long term structural damage to the spinal bones you need the right medication along with:
- Daily exercise routine
- Posture management
- Lifestyle changes
Ask your Rheumatologist for biologics that slow down spinal fusion.
References
- Magrey MN and Khan MA. Curr Rheumatol Rep 2017;19:17
- van der Heijde D, et al. Ann Rheum Dis 2017;0:1–14
- NASS. Available [Online] at: http://nass.co.uk/about-as/living-well-with-as/medication-for-as/Accessed on 6 Sept 2017
- Ankylosing spondylitis and related conditions. Available [Online] at URL: http://www.wales.nhs.uk/sitesplus/documents/866/2001-Ankylosing-spondylitis[1].pdfAccessed on 4th Oct 2019
- Biologic therapy. National Ankylosing Spondylitis Society. Available [online] at URL: http://nass.co.uk/aboutas/living-well-withas/medication-for-as/anti-tnf-therapy/Accessed on 9th June 2017
- Biologic Therapies for Axial SpA (AS). Available [Online] at: https://nass.co.uk/resource/nass-guide-to-biologic-therapy/Accessed on 26 June 2020
- Treatment. Ankylosing Spondylitis. Available [Online] at: https://www.nhs.uk/conditions/ankylosing-spondylitis/treatment/Accessed on 26 June 2020
- Disease Modifying Anti-Rheumatic Drugs. Available [Online] at: https://nass.co.uk/managing-my-as/medication/dmards/ Accessed on 26 June 2020