A change in medication may cause new or worsening symptoms of ankylosing spondylitis, even if other symptoms improve. A doctor may need to prescribe a combination of medications to relieve a person’s symptoms.

Ankylosing spondylitis is a form of arthritis that affects the spine and causes back pain and stiffness. It can also cause pain and stiffness in other joints, such as the hips, shoulders, knees, ankles, and feet.

Getting treatment for ankylosing spondylitis is important for reducing inflammation, relieving symptoms, and slowing the development of the disease.

Read on to find the answers to some of the most pressing questions about ankylosing spondylitis treatments.

Depending on a person’s symptoms and medical history, a doctor may recommend one or more of the following treatments for ankylosing spondylitis:

  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
  • a biologic, such as:
    • a tumor necrosis factor inhibitor, such as:
      • etanercept (Enbrel)
      • adalimumab (Humira)
      • remicade (Infliximab)
      • golimumab (Simponi)
      • certolizumab pegol (Cimzia)
    • an interleukin (IL)-17 inhibitor, such as:
      • secukinumab (Cosentyz)
      • ixekizumab (Taltz)
    • an IL-12/23 inhibitor, such as:
      • ustekinumab (Stelara)
  • a Janus kinase (JAK) inhibitor, such as:
    • tofacitinib (Xeljanz, Xeljanz XR)
    • upadacitinib (Rinvoq)
  • sulfasalazine (Azulfidine)
  • methotrexate (Rheumatrex)
  • corticosteroid injections
  • physical therapy
  • surgery

Different people respond differently to treatments. Sometimes a person may need to try more than one treatment or combination of treatments to find what works well for them.

A person’s doctor might recommend a change in their treatment plan if:

  • they still have symptoms, despite their current treatment
  • imaging tests show that the disease is progressing, despite their current treatment
  • they develop side effects from their current treatment that are hard to manage
  • they can no longer afford their current treatment
  • a better treatment option becomes available

A doctor can help an individual understand the potential benefits and risks of different treatment options.

Sometimes people develop new or worsening symptoms after changing treatments for ankylosing spondylitis.

This can happen for a variety of reasons.

“Sometimes patients don’t realize how much a medication may be helping them. If their symptoms haven’t completely gone away, they might think, ‘alright, maybe this treatment isn’t working, so let’s try something else.’ But when they stop that medication, they may find it was controlling some symptoms that the new medication isn’t controlling as well,” Dr. Waseem Mir, MD, a rheumatologist at Lenox Hill Hospital in New York City, told Medical News Today.

“The new medication may not be as good at covering those symptoms, or maybe it just hasn’t kicked in yet,” he added.

Certain medications may be more effective than others for relieving certain symptoms. A change in medication may cause some symptoms to appear or worsen, even if other symptoms improve. A doctor may need to prescribe a combination of medications to relieve a person’s symptoms.

Medications for ankylosing spondylitis may also cause side effects or interact with other medications or supplements, which can cause symptoms.

Someone who develops new or worsening symptoms after changing treatments should inform a doctor.

A doctor can help determine whether the symptoms are:

  • due to ankylosing spondylitis
  • side effects from treatment
  • drug interactions
  • another cause

A doctor may recommend changes to a person’s treatment plan or encourage them to give their current treatment more time to work.

“In general, you want to give a new medication 3 months to see if it works. If symptoms are not improving by that point, it’s time to see if you can find a better medication,” said Dr. Wir.

Drug developers must conduct studies that show that a new medication is generally safe and effective before the Food and Drug Administration (FDA) will approve that treatment.

Even so, all medications carry some risk of side effects. The risks can vary from one person to another, depending on their medical history. The safest treatment option for one person may not be safe for another person.

Before a person tries a new treatment, they should talk with a doctor to learn about the potential benefits and risks. The doctor can help them learn whether safer treatment options may be available. They can also help them learn how to recognize and manage potential side effects from treatment.

A doctor may order regular blood and imaging tests to determine how well someone’s treatment is working and check for signs of potential side effects.

If someone thinks they may be experiencing side effects from treatment, they should talk with the doctor right away.

The first-line treatment for ankylosing spondylitis is NSAIDs combined with physical therapy. If someone has symptoms in peripheral joints, such as their shoulders, knees, ankles, or feet, a doctor may also prescribe corticosteroid injections or sulfasalazine to manage those symptoms.

If this combination of treatments is not enough to manage inflammation and relieve symptoms, the next line of treatment is usually a TNF inhibitor, such as adalimumab (Humira) or infliximab (Remicade).

TNF inhibitors are biologic disease-modifying drugs that help block inflammation. This reduces symptoms and lowers the risk of lasting joint damage from ankylosing spondylitis.

TNF inhibitors may not be safe for people with certain medical conditions, such as congestive heart failure or hypersensitivity to this type of medication. If someone has a medical condition that makes TNF inhibitors less safe, their doctor may prescribe a different type of medication instead.

If someone tries a medication that does not work well for them or that stops working over time, their doctor may prescribe a different medication. Their doctor may also recommend a change in treatment if the person develops side effects from treatment that are difficult to manage.

Sometimes doctors prescribe a combination of medications to treat ankylosing spondylitis.

JAK inhibitors are among the newest treatment options for ankylosing spondylitis. This type of medication blocks the action of certain kinds of tyrosine kinases, which are proteins that help drive inflammation.

JAK inhibitors provide a treatment option when biologic medications such as TNF inhibitors and IL-17 inhibitors do not work well or stop working over time.

Researchers are continuing to develop and test new types of treatments for ankylosing spondylitis, including new types of biologics, JAK inhibitors, and other medications.

A person can talk with a doctor to learn more about new treatment options. Sometimes the doctor may encourage them to try a newer treatment or take part in a clinical trial to receive a treatment that the FDA has yet to approve. Their doctor can help them learn more about the potential benefits and risks of taking part in a clinical trial.

For many people, a combination of medications and non-drug treatments is most effective for managing ankylosing spondylitis.

The condition develops when the immune system attacks joints in the spine and other parts of the body. This causes inflammation that can lead to lasting joint damage.

Physical therapy exercises may help improve muscle strength and flexibility, which may help improve joint function.

Certain lifestyle changes may also have benefits for improving physical function, such as:

  • managing weight
  • exercising regularly
  • practicing good posture
  • using assistive devices, such as a cane or walker
  • quitting or avoiding smoking, if necessary
  • limiting stress

However, physical therapy and lifestyle changes alone are not enough to stop the immune reaction that causes inflammation and joint damage in ankylosing spondylitis.

To treat the condition, the American College of Rheumatology recommends early and ongoing treatment with medications such as NSAIDs, TNF inhibitors, or other disease-modifying drugs. This is important for relieving symptoms, limiting joint damage, and lowering the risk of complications.

Ankylosing spondylitis can cause back pain and stiffness, as well as symptoms in other joints.

Getting treatment is important for reducing inflammation, relieving symptoms, and preventing the condition from worsening.

The first line of treatment is NSAIDS combined with physical therapy. Some people may also benefit from local corticosteroid injections or other medications.

If the first treatment does not work well, stops working over time, or causes side effects that are hard to manage, a person’s doctor may prescribe another medication.

Someone may need to try multiple treatments to find what works well for them.