Medications for Axial Spondyloarthritis
Although 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 maximize quality of life, prevent or slow progressive structural damage, and control symptoms and inflammation and preserve mobility.1
The 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, and whether your disease is active or stable. Think of your treatment plan as a dynamic thing; it can change – and should change – based on your response to treatment and how it’s working for you.
One of the treatments used for AxSpA spectrum conditions is medication. There are different kinds of medication, and what works for one person may not be effective for another. The US Food and Drug Administration (FDA) has approved drugs for ankylosing spondylitis (AS), also called r-AxSpA, and there are a few drugs currently approved for nr-AxSpA.2 Often times, people with comorbid disorders use medication for those disorders to relieve some AxSpA spectrum symptoms as well.
Knowing more about the medications available 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 the first-line of medications typically used to treat musculoskeletal symptoms of AxSpA spectrum conditions. These drugs are effective in combatting inflammation because they stop the synthesis of prostaglandins, which are involved in the inflammatory process.3
Long-term chronic use of these medications is not generally recommended, as it increases the risk of peptic ulcer disease, acute kidney failure, and stroke or heart attack.4 Long-term, chronic use of NSAIDs can also make cardiovascular disease or hypertension worse, and interact with various other drugs. These risks may be especially significant in older adults.
These drugs often do not remain effective by themselves in treating the symptoms of AxSpA spectrum conditions, and other medications are usually tried. It is not clear if NSAIDs are effective in slowing down structural damage to bones; more research is needed.
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 and can help slow down joint damage, reduce flare-ups, and help control symptoms.5 These drugs have been used traditionally 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.
Traditional DMARDs work by interfering with parts of the inflammatory cascade.5 Different DMARDs work in different ways, affecting several different biological processes or cells. Biologic DMARDs are a little different, and more selective in how they work. They are more targeted toward interfering with cytokine function (which is involved in inflammation), stopping certain cell activations in the immune reaction, and getting rid of or inhibiting other cells involved in the immune response.5
DMARDs are powerful drugs and have a variety of possible side effects, including rash, gastrointestinal issues, liver toxicity, low white blood cell count and infection, and liver disease.5 They may not be for everyone.
Other medications that may be used in the treatment of AxSpA spectrum conditions can include a Janus kinase (JAK) inhibitor called tofacitinib, which is often taken alongside other DMARDs.6,7
Talk with your doctor about the symptoms you’re experiencing, and what helps and doesn’t help. They can work with you to find the right medication for your symptoms and overall health. Sometimes you have to try more than one drug to find the right one for you, so don’t get discouraged if the first medication isn’t right for you.