Medicines for Axial Spondyloarthritis

Reviewed by: HU Medical Review Board | Last reviewed: May 2022 | Last updated: June 2022

While axial spondyloarthritis (AxSpA) is a chronic, progressive condition, there are treatments for it. There is no cure, but treatments are available to help you manage the condition. Rather than cure, the goals of treatment are to:1

  • Maximize quality of life
  • Prevent or slow progressive structural damage
  • Control symptoms and inflammation
  • Preserve mobility

Your treatment plan can vary depending on where your disease activity is on the AxSpA spectrum. It also varies depending on:

  • Your symptoms
  • Your overall health
  • Any comorbid conditions you might have
  • Whether your disease is active or stable

Think of your treatment plan as a dynamic thing. It can – and should – change – based on your response to treatment and how it is working for you.

Medicines can be used to treat AxSpa spectrum conditions. There are different kinds of medicines used, and what works for 1 person may not be effective for another. The U.S. Food and Drug Administration (FDA) has approved drugs for ankylosing spondylitis (AS), also called r-AxSpA. There are also a few drugs approved for nr-AxSpA. In many cases, people with other health conditions use medicine for those disorders to also relieve some AxSpA spectrum symptoms.2

Knowing more about the drugs used to treat the spectrum of AxSpA conditions can help you talk with your doctor about what might be best for you at a given time.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first drugs used to treat musculoskeletal symptoms of AxSpA spectrum conditions. These drugs work on hormones that can create inflammation.3

Long-term use of NSAIDs is not generally recommended. This is because they increase the risk of peptic ulcer disease, acute kidney failure, and stroke or heart attack. Long-term use can also make heart disease or hypertension worse and interact with other drugs. These risks may be especially serious in older adults.4

These drugs often do not remain effective by themselves in treating the symptoms of AxSpA spectrum conditions. Other drugs are usually tried. It is not clear if NSAIDs are effective in slowing down structural damage to bones. More research is needed to understand this.

Disease-modifying antirheumatic drugs (DMARDs)

If NSAIDs are not effective or stop being effective, other drugs like disease-modifying antirheumatic drugs (DMARDs) are used. DMARDs are drugs that suppress the immune system. They can:5

  • Help slow down joint damage
  • Reduce flare-ups
  • Help control symptoms

These drugs have traditionally been used to treat rheumatoid arthritis (RA) but have also been used to treat AxSpA spectrum conditions. There are 2 main types of DMARDs: traditional (which includes synthetics) and biologic.5

Different DMARDs work in different ways, affecting several different biological processes or cells. Traditional DMARDs work by interfering with parts of the inflammatory process. Biologic DMARDs are a little different and more selective in how they work. They are more targeted toward:5

  • Interfering with cytokine function (which is involved in inflammation)
  • Stopping certain cell activations in the immune reaction
  • Getting rid of or blocking other cells involved in the immune response

DMARDs are powerful drugs. They also have a variety of possible side effects, including rash, liver problems, and infection. They may not be for everyone.5

Other medicines

Other medicines used in the treatment of AxSpA spectrum conditions include a Janus kinase (JAK) inhibitor called tofacitinib. This is often taken along with other DMARDs.6,7

Talk with your doctor about the symptoms you are experiencing, as well as what does and does not help. They can work with you to find the right medicine for your symptoms and overall health. You may have to try more than one drug to find the right one for you. Do not get discouraged if the first medicine is not right for you.

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