Is It Time to Try a New Ankylosing Spondylitis Medication?

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Ankylosing spondylitis (AS) is form of spinal arthritis. Though the lower back and pelvis are most frequently affected, in some cases it can spread to other parts of your body, including your shoulders, hips, ribs, and feet. When AS becomes severe, new bone can grow in between the affected vertebrae of your spine, causing them to fuse together and making it hard to move. 

Since AS can change over time, it’s not uncommon your treatment may need to change along with it. But how do you know when it’s time? Here are some signs that you should consider talking to your doctor about trying a new ankylosing spondylitis medication.

1. Your ankylosing spondylitis pain isn’t under control anymore.

The goal of ankylosing spondylitis treatment is to decrease painful inflammation so you can keep living a good quality of life. But if you’re experiencing worsening or more frequent bouts of pain or stiffness, let your doctor know.

Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, are usually the first line of treatment for AS. Your doctor may recommend trying a higher dose. If that can’t be done, there are a few other kinds of medications to try:

  • Steroids: Steroids like prednisone may be ordered during times when your AS symptoms flare. Steroids can improve inflammation but are generally used only for short periods of time.

  • Disease-modifying antirheumatic drugs (DMARDs): These medications, such as methotrexate, also help to reduce inflammation and prevent joint damage. They seem to work best for pain that has spread to your peripheral joints.

  • Biologics: This newer class of medication targets specific proteins in your body to stop the inflammatory response. Not only do they help improve pain, but they may also slow the progression of AS. Examples include adalimumab (Humira), etanercept (Enbrel), and secukinumab (Cosentyx).

Keep in mind your response to a drug for ankylosing spondylitis is unique to your case. And even if a particular medication stops working well to control your symptoms, another medication (even from the same class) may bring you the relief you’re seeking.

2. You can’t handle the side effects of your current ankylosing spondylitis treatment.

Most medications can have potential side effects, so you need to strike a balance, finding one that works for you but has minimal side effects. For example, NSAIDs can damage the lining of your stomach, causing bleeding or ulcers, and biologics can weaken your immune system, putting you at greater risk for infection. When side effects become too much, it’s probably a good idea to ask your doctor about starting a new AS medication.

3. You’re having a hard time taking your ankylosing spondylitis medication as directed.

For a medication to work properly, you must be compliant with taking it as prescribed. If you’re struggling to stick to your current treatment plan, maybe there’s a better option available for you.

Drugs for AS may be given as a pill, an injection, or an infusion into a vein. Say you’re having difficulty remembering to take your naproxen pill every day. Perhaps switching to a biologic like etanercept (Enbrel) that only needs to be injected once a week would be easier. Or if you can’t stomach the thought of giving yourself a shot, maybe you’d prefer to go to the doctor’s office for an infusion of a different biologic such as golimumab (Simponi Aria) every 4-8 weeks.

Only your doctor can determine if a particular medication is appropriate for treating your ankylosing spondylitis, but don’t be afraid to ask if you think another method would be more suitable.

4. You’ve developed complications with other organs as a result of your ankylosing spondylitis.

Occasionally, the inflammation from AS can go beyond the joints and impact other organs of the body. Your eyes are most likely to be affected, leading to a red and painful eye condition known as uveitis. Problems with the bowel, including inflammatory bowel disease, are another possibility. In rare cases, inflammation can occur in your heart or your lungs.

If you notice any new health problems, even if you’re unsure whether it’s related to your ankylosing spondylitis, notify your doctor. If your doctor determines they’re connected, you may be able to add to or switch your current medication to provide better coverage for multiple health conditions.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Dec 26
  1. Ankylosing Spondylitis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808
  2. Ankylosing Spondylitis. National
    Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/ankylosing-spondylitis
  3. Medications to Treat Back Pain. Arthritis Foundation. https://www.arthritis.org/about-arthritis/where-it-hurts/back-pain/treatment/back-pain-treatment-med...
  4. Spondyloarthritis
    Medications Overview. Spondylitis Association of America. https://www.spondylitis.org/Medication-Guide
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