Your Guide To Axial Spondyloarthritis Treatments
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Whether you’ve been newly diagnosed with axial spondyloarthritis (axSpA) or have been living with the condition for a while, it’s reasonable to have questions about treatments that could make you feel better. After all, the right medications can help you manage the symptoms that come along with your condition, and even the disease itself.
“The correct diagnosis and the proper treatments are critical for relieving the pain that patients experience from axial spondyloarthritis,” says Sandeep Agarwal, MD, a rheumatologist and associate professor of medicine at the Baylor College of Medicine. They can even prevent damage to the spine and joints that could otherwise lead to permanent disability down the road, he adds.
If you’re dealing with pain and stiffness from the condition, you’re not alone. “The symptoms include back pain, but primarily stiffness,” says Alexis Ogdie, MD, a professor of rheumatology at Penn Medicine in Philadelphia. “People wake up in the morning and they have trouble moving. Sometimes they also get swelling in their joints.”
But the right treatment can help, and when it comes to finding the proper treatment for your axSpA, it’s best to have a conversation with your doctor about what you hope to achieve and how particular medications may fit into your lifestyle. “This is a two-way discussion, a shared decision-making process,” says Orrin Troum, MD, a rheumatologist at Providence Saint John’s Health Center, in Santa Monica, California. It’s also wise to have some idea of what you’ll discuss with them beforehand, so you can carefully weigh your choices. “This is a critical discussion, where patients get to ask about benefits and side effects,” Dr. Troum says.
With all that in mind, here are the major medications currently used to treat axial spondyloarthritis and why you might consider taking them, as well as potential side effects to have on your radar for each.
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NSAIDs
What are they?
These medications reduce both pain and inflammation; you are likely familiar with over-the-counter versions such as ibuprofen and naproxen. Other types require a prescription. Dr. Agarwal calls NSAIDs a “first-line treatment” for axial spondyloarthritis.
Why might you consider taking them?
NSAIDs are used mainly for pain management and to decrease inflammation, Dr. Troum says. “They usually work within a few doses,” Dr. Ogdie adds. “You’re really looking for a decrease in stiffness.” These medications can be “moderately effective in treatment of symptoms and even in preventing damage and fusion of the spine,” Dr. Agarwal says, but he also points out that an NSAID also may not be strong enough to manage your pain. “Patients can experience fairly quick pain relief, but these are often not sufficient.”
What are the side effects?
NSAIDs can cause nausea or an upset stomach, and they increase the risk of stomach and intestinal ulcers, Dr. Troum says. “For patients at risk, NSAIDs are also known to increase blood pressure and therefore potentially the risk of heart attack,” he adds.
Disease-Modifying Antirheumatic Drugs (DMARDs)
What are they?
DMARDs are medications designed to decrease inflammation and pain, reduce tissue damage, and slow the progression of disease. They all require a prescription. There are many medications in this class, but the ones used most often for axial spondyloarthritis are the TNF inhibitor sulfasalazine and the JAK inhibitor methotrexate, Dr. Agarwal notes.
Why might you consider taking them?
“DMARDs can be used in patients with axial spondyloarthritis when they have inflammation of peripheral joints, such as the hips, knees, ankles, and wrists,” Dr. Agarwal says. “The benefits take several months, but these medications can be effective.” Keep in mind, though, that they don’t do a lot to treat the spinal issues related to the condition.
What are the side effects?
If you take a DMARD, Dr. Agarwal says, you’ll need to be monitored for side effects. They can vary based on the type you’re taking, but can include loss of appetite, nausea, diarrhea, abdominal pain, rashes, liver problems, an increased risk of infections, and low white and red blood cell counts, as well as low platelet counts.
Biologics
What are they?
Biologics are a subset of DMARDs that are created using living cells from animals, humans, and other microorganisms. They include TNF, interleukin-1, interleukin-6, T-cell, B-cell, and JAK inhibitors, and each is made up of proteins that target the specific molecules, cells, and pathways that cause inflammation and damage tissue. They are only available with a prescription and usually need to be given via injection or infusion, although JAK inhibitors come in a pill form and are taken by mouth, Dr. Troum says. The main biologics used for axial spondyloarthritis include the TNF inhibitors adalimumab, certolizumab, and infliximab.
Why might you consider taking them?
Biologics are sometimes prescribed when regular DMARDs do not provide the desired relief, but some are especially effective at treating the impact of axial spondyloarthritis on the spine and sacroiliac joints (those that link the pelvis and lower spine). “Biologics can also be beneficial in the peripheral joints, as well as to address symptoms beyond those in the spine and joints, such as inflammation of tendon insertion sites, inflammation in the eye, psoriasis of the skin, and inflammation in the colon,” Dr. Agarwal says. Some patients see a benefit in as little as a month, but for most it takes three to six months, Dr. Troum adds.
What are the side effects?
There are a few to have on your radar, including a higher-than-usual risk of common and serious bacterial, fungal, and viral infections; reactivation of tuberculosis, herpes zoster, or hepatitis B and C; an increase in cholesterol levels, low blood-cell counts, and increased liver enzymes; and a higher risk of blood clots (with JAK inhibitors specifically). There are other side effects as well that are specific to each particular medication; be sure to ask your doctor about them based on which you’re considering.
Corticosteroids
What are they?
Corticosteroids are prescription medications that have a range of effects in the body and can treat many different conditions. They are the synthetic version of natural steroid hormones that are produced in the cortex of the adrenal glands, which are located near the kidneys. Immunosuppressive and anti-inflammatory, they are used in many areas of medicine.
Why might you consider taking them?
In the case of axial spondyloarthritis, corticosteroids are used to suppress the immune system, Dr. Troum says, adding that they’re designed to be used only for a brief period of time. “They can be used temporarily for acute flares or severe symptoms, but they are intended more as a short-term solution while the patient and rheumatologist are selecting better, more long-term treatments with DMARDs and biologics,” Dr. Agarwal says. These medications go to work within a day or two and include things like cortisone shots directly into affected joints or taking oral prednisolone.
What are the side effects?
“We prefer not to use corticosteroids as a long-term treatment due to their long list of side effects,” Dr. Agarwal says. These can include trouble with wound healing, bruising, thinning skin, acne, excessive hair growth, swelling, a higher risk of infections, and gastrointestinal bleeding.
This is just an introduction to treatments for Axial spondyloarthritis. If you have questions about any of these medications and how they may be a good fit for you, talk to your doctor.
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