Ankylosing spondylitis (AS) is a type of chronic arthritis. It mainly causes inflammation of the spinal joints and areas where cartilage, ligaments, and tendons meet the bones.
Sometimes, extra bone formation can result in the fusion of the lower vertebrae, making the spine less flexible. Eye inflammation, compression fractures, and heart issues may also occur with AS.
AS affects up to 1% of adults in the United States. Because it is such a complex condition, it is understandable that people have questions.
For answers to some common questions about AS treatments and how close researchers are to a cure, read more below.
There is currently no cure for AS, though there are a variety of treatments available to help control the symptoms and delay disease progression.
Some current treatment options include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). People often use ibuprofen (Advil) and naproxen (Aleve) as first-line medications to help control the inflammatory process and pain. These medications do not help slow the progression of AS, however.
- Analgesics. When NSAIDs alone do not provide sufficient relief, doctors may also prescribe analgesics, such as acetaminophen (Tylenol), either on their own or combined with a narcotic such as codeine.
- Corticosteroid injections. These injections, like prednisone, can help fight inflammation to temporarily ease AS symptoms. People do not typically use them long term due to the risk of severe side effects.
- Disease-modifying antirheumatic drugs. People often use these medications, including methotrexate (Rheumatrex) and sulfasalazine (Azulfidine), to treat conditions such as rheumatoid arthritis or inflammatory bowel disease. Doctors generally do not prescribe them for spinal arthritis, though people can use them to treat cases of AS that affect other joints in the body.
- Biologic drugs. These help relieve AS symptoms and prevent disease progression by targeting underlying inflammation. Biologics that people use for AS include tumor necrosis factor antagonists such as etanercept (Enbrel) or adalimumab (Humira) and interleukin 17 inhibitors such as ixekizumab (Taltz) or secukinumab (Cosentyx). Researchers are also looking into other biologic drugs, such as bimekizumab, for treating AS.
Biologics are the newest, most targeted form of AS treatment that the Food and Drug Administration (FDA) have approved. However, researchers are constantly searching for new ways to better treat this condition and hopefully find a cure.
Below are a few treatment options that may be coming down the pike for AS.
Janus kinase inhibitors: A potential upcoming AS treatment
Janus kinase (JAK) inhibitors work by targeting a specific pathway that experts believe is involved in the underlying inflammatory disease response.
JAK inhibitors currently have approval to treat other types of arthritis, such as rheumatoid arthritis and psoriatic arthritis. Researchers have been looking into whether or not these drugs can also help treat AS.
Results from another phase 2 clinical trial studying the use of a JAK inhibitor called tofacitinib found that participants taking the drug experienced at least a 20% improvement in AS disease activity, back pain, inflammation, and overall function.
Another study into tofacitinib found that over 56% of participants taking the drug experienced these improvements.
Researchers are also studying a JAK inhibitor called upadacitinib. Results from phases 2 and 3 of an ongoing AS trial have found that 52% of participants taking the drug experienced improvements in pain, inflammation, and overall function.
Although these results are promising, more studies are necessary before the FDA can approve these drugs for use in treating AS.
Understanding the genetic aspect of AS
Although researchers do not know exactly what causes AS, they do believe that genetic factors play a role.
HLA-B27 is a genetic marker present in 90–95% of those with AS in some ethnic populations. In one 2017 study, HLA-B27 occurred least frequently in Black people (62.5%) compared with white people (85.3%) and Latino people (86.7%).
Learning more about the correlation between genetics and AS may further help researchers advance treatment options.
People typically receive medications that treat chronic conditions such as AS in one of three ways: orally, by skin absorption, or by injection.
However, these options have some drawbacks, including the fact that:
- People need to continuously take the medications.
- The medications take time to clear from the body, which can lead to complications and potential toxicity.
- The cost of ongoing treatment is high.
So, researchers are exploring nanotechnology as another way of administering treatment to help solve these issues.
Scientists have studied how nanotechnology can help with inflammatory conditions such as osteoarthritis and rheumatoid arthritis. Although testing for AS is still in the future, it may eventually help enhance AS treatment.
AS itself does not shorten life span. However, complications that affect people with AS have been linked to reduced life expectancy.
For example, heart disease is a serious complication associated with AS. A 2015 study suggests that people with AS had a 35% higher chance of having a heart attack and a 60% higher chance of experiencing stroke than people without AS.
Doctors typically diagnose AS in people under age 45 years. It is a lifelong condition.
Most people with AS experience periods wherein painful symptoms can appear, called flares, followed by periods of remission. These periods can last anywhere from a few days to months.
Although treatments have come a long way in managing AS symptoms, at the moment, there is no cure for the condition.
AS can affect people in different ways, and the symptoms may change over time. Some people with AS experience only occasional back pain, whereas for others, it can be a debilitating condition. In fact, in severe cases, AS can lead to disability.
Early diagnosis and management of AS can reduce damage to the spine and joints. People with AS should speak with a doctor to learn how to manage the condition optimally and lead as normal a life as possible.
There is currently no cure for AS. As more research is taking place, we are learning more about AS and how best to treat it.
Ongoing clinical trials are looking into treating AS with targeted drugs called JAK inhibitors to help relieve the symptoms and prevent disease progression.
Researchers are also exploring the link between AS and genetics to help inform future therapeutic options. Scientists are also conducting studies into nanotechnology to enhance treatment administration in inflammatory conditions such as AS.
They are continuously working to find better treatments to control and, one day, cure the condition.