9 FAQs About Ankylosing Spondylitis Treatment
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When you have ankylosing spondylitis (AS), a form of arthritis that causes joint and spine inflammation, you’re likely to experience pain and stiffness, especially in your lower back and buttocks. The pain may come and go or be ongoing, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. While there’s no cure for AS, there are effective treatments, says Dalit Ashany, MD, a rheumatologist at the Hospital for Special Surgery in New York City and an assistant professor of medicine at Weill Cornell Medical College.
Here’s what you should know about treating AS, along with answers to some of the most frequently asked questions Dr. Ashany hears from her patients:
How do I treat ankylosing spondylitis?
Doctors usually start by recommending an NSAID (nonsteroidal anti-inflammatory drug). “We start with a full course, meaning not taken as needed but the maximal dose per day for three to four weeks, to see if there’s a response,” Ashany says. “If there’s no response to one anti-inflammatory, we try another and do the same thing.” If anti-inflammatories don’t help, the next option is an injectable medication called an anti-TNF (tumor necrosis factor) agent. These biologic drugs work by blocking cytokines, small proteins produced by cells that cause inflammation, according to the Arthritis Foundation. Most people do well on either anti-inflammatories or anti-TNF-agents, or sometimes both, Ashany says. A newer biologic, secukinumab, which targets the cytokine interleukin-17 was approved as an AS treatment in January 2019 by the Food and Drug Administration.
In addition to medication, your treatment might include exercises to help maintain flexibility, using the correct posture to reduce strain on the spine, heat and cold therapy, and possibly surgery to correct severe deformities, according to the Spondylitis Association of America.
Will I have to take the drugs forever?
Most people need to remain on some medication for the rest of their lives after they have been diagnosed with AS. “The majority find that without medication, their symptoms regress,” Ashany says.
Will the medications halt the progression of my disease?
The medications can help people manage their symptoms, which helps them lead their lives and not deal with chronic pain all the time, Ashany says. “But currently, when we check X-rays or MRIs, we’re not seeing evidence that there’s a significant a change in the disease progression, even after treatment,” she adds.
What are some of the side effects from drugs that I should be aware of?
Some people find that NSAIDs cause gastritis, heartburn, and ulcers, according to the Spondylitis Association. “Many of our AS patients are young, so they can tolerate the anti-inflammatories in terms of their stomachs,” Ashany says. “Older patients often have more trouble taking anti-inflammatories on a regular basis.” Taking antacids should help, as they coat the stomach and lower the risk of heartburn and ulcers, according to the Spondylitis Association.
Anti-inflammatories can affect liver and kidney function over time and cause high blood pressure. “I tell patients, ‘We will monitor you carefully for these side effects,’” Ashany says. “We do blood tests at least once a year.”
Because anti-TNF agents suppress your immune system, they can make you more susceptible to infections. “If you get an infection, you have to stop your medication, take your antibiotics, and start again when your infection is cleared,” Ashany says.
Can I skip a dose?
With anti-inflammatories, the most recent data suggest that you don’t need to take them round the clock, Ashany says. “With the anti-TNFs, we recommend you take them as prescribed, even if you’re feeling well,” she notes. “Some patients on their own will increase the intervals. If they’re supposed to take it weekly, they might take it every 10 days and slowly increase the time between injections.” There is some evidence that if you stop an anti-TNF agent, you may lose some of the effectiveness when you restart, she explains.
How soon will I feel better?
Both NSAIDs and anti-TNFs take about three to four weeks to provide relief. “Some patients will feel better only if they continue treatment for three months, but the chance of success diminishes the longer it takes,” Ashany says. “If it doesn’t work in three months, then we will stop and look for something else.”
Can my medication stop working?
Yes, that can happen, Ashany says. “It’s unpredictable,” but there are options, she adds. “If you’ve had a good response to an anti-TNF agent and it stops working, then we can switch to a second and see if that works. You can keep switching. I will sometimes go through all available medications before giving up on that class of medication.”
Could I be a candidate for a DMARD?
DMARDs — short for disease-modifying anti-rheumatic drugs — are a class of medications used to treat chronic conditions like rheumatoid arthritis; however, they have not proved effective at treating the back issues associated with AS. That being said, some people with AS also have peripheral disease — pain in joints outside the spine — and DMARDS may be used to treat this pain in the knees or hips, Ashany says.
Are complementary and alternative treatments safe?
Some people find that yoga, meditation, and acupuncture help with pain or their ability to sleep, but there’s no scientific evidence to support these practices for AS, Ashany says.
Video: 2. What is a Biological and how does it help my Ankylosing Spondylitis.
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