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Medications for Axial Spondyloarthritis

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By Editorial Team

3 min read

Reviewed by: HU Medical Review Board | Last updated: June 2024

Axial spondyloarthritis (axSpA) is a long-term condition that slowly gets worse. If left untreated, axSpA may lead to long-term joint damage and disability. Over time, the spinal joints may grow together, or fuse. This fusion can lead to a decrease in flexibility. There is no cure for axSpA, but there are treatments that can help manage symptoms.1

The goals of treating axSpA include:1

  • Managing pain and other symptoms
  • Reducing inflammation
  • Preventing further joint damage
  • Improving function and quality of life
  • Decreasing the need for medicines

Treatment often includes lifestyle changes, such as exercising regularly and eating a healthy diet. For some people with severe axSpA, surgery may be needed. Many people living with axSpA take medicines to help reduce symptoms.1

Types of medicines for axial spondyloarthritis

Drugs used to treat axSpA help decrease inflammation, reduce pain and stiffness, and slow down joint damage.1

There are several types of medicines used to treat axSpA, including:1

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Disease-modifying antirheumatic drugs (DMARDs)
  • Steroid drugs

NSAIDs

NSAIDs help reduce inflammation and pain. They are usually the first type of drug used to treat axSpA. They are generally affordable and available over the counter (OTC).1,2

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Examples of OTC NSAIDs include:2

  • Ibuprofen (Advilx®, Motrinx®)
  • Naproxen (Alevex®)
  • Aspirin (Bayer®)

Stronger NSAIDs may be available with a prescription. These have stronger effects but often have more severe side effects, especially if taken over a long period. There are dozens of prescription NSAIDs available. Some, such as Voltaren, are applied to the skin rather than taken as a pill.2

Common prescription NSAIDs include:2

  • Celecoxib (Celebrex®)
  • Diclofenac (Voltaren)

Long-term use of NSAIDs increases the risk of certain health problems, such as stomach bleeding, stroke, and kidney failure.2

DMARDs

DMARDs are used to help slow down the progression of axSpA and reduce inflammation. There are 3 types of DMARDs:1,3

  • Conventional (traditional)
  • Biologic
  • Targeted synthetic

Conventional DMARDs

Conventional DMARDs are older drugs. These are generally affordable but have more side effects than newer DMARDs. Examples of these DMARDs include:3,4

  • Methotrexate
  • Sulfasalazine (Azulfidine)

New treatment guidelines do not include these drugs for treating axSpA. But some people may benefit from them.4

Biologic DMARDs

Biologic DMARDs are drugs made in a lab using living cells. This is different than traditional drugs, which are made from chemicals.3

The biologics most often prescribed for axSpA include:4

  • Tumor necrosis factor (TNF) inhibitors
  • Interleukin 17-A (IL-17A) inhibitors

These are usually a second choice for treatment if NSAIDs are not relieving your pain and inflammation.4

Targeted synthetic DMARDs

Janus kinase (JAK) inhibitors are a type of targeted synthetic DMARD. JAK inhibitors target specific processes in the body related to inflammation.3,4

Currently, 2 JAK inhibitor drugs have been approved by the US Food and Drug Administration (FDA) to treat adults with certain cases of axSpA:4-6

  • Xeljanz® (tofacitinib)
  • Rinvoq® (upadacitinib)

These are also a second-choice treatment option when NSAIDs fail to provide pain relief.4

Steroids

Steroids, also called corticosteroids or glucocorticoids, act similarly to a hormone your body produces called cortisol. Cortisol is made by your adrenal glands. It affects various body functions, including inflammation.7,8

Steroids are sometimes used for a short time to reduce pain and swelling. They can be taken as a pill or injected into a muscle or joint. But doctors consider the risks before they decide whether steroids are a good idea for each person.7,8

Long-term use of steroids is not recommended. Health problems like weak bones, high blood pressure, and diabetes can result from long-term steroid use.4,7,8

Common steroids include:7,8

  • Prednisone
  • Methylprednisolone
  • Cortisone
  • Hydrocortisone

Before beginning treatment for axSpA, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes OTC drugs. And remember that all drugs have side effects and should be used with caution. Talk to your doctor about the risks and benefits of medicines used to treat axSpA.

Treatment results and side effects can vary from person to person. This treatment information is not meant to replace professional medical advice. Talk to your doctor about what to expect before starting and while taking any treatment.