Different types of medications are used to treat ankylosing spondylitis (AS). These can all help to manage pain, stiffness, and inflammation. Medications can also help to slow the progression of AS and prevent joint fusion.
Biologics are one type of medication that you may take for your AS. You might continue to take other medications along with a biologic.
Biologics modify your immune response to prevent symptoms of AS. Your immune system is designed to protect your body from harmful invaders. Inflammation is a normal and helpful response if your body is fighting an infection.
This strategic attack typically turns off once an infection is gone. With an inflammatory condition like AS, the immune system accidentally targets a healthy body part. The inflammatory response does not shut off and starts to cause damage.
In AS, this leads to pain, stiffness, and swelling in the spine and other large joints. Spinal fusion can also occur due to long-term inflammation from AS, and biologics can help prevent this from happening.
Biologics target specific proteins in the immune system. They block the action of these proteins to prevent the inflammatory response.
Biologics are medications that target specific immune responses and are used to treat many inflammatory conditions. There are two groups of biologics approved for AS treatment in the United States, and several medications within these groups.
Tumor necrosis factor (TNF) inhibitors
The first type is tumor necrosis factor (TNF) inhibitors. This was the first type of biologic to be approved for AS. TNF is a protein sent out by the immune system that triggers inflammation. TNF inhibitors block these proteins so they aren’t able to cause the inflammatory symptoms of AS.
The TNF inhibitor biologics approved for AS in the United States are:
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- etanercept (Enbrel)
- golimumab (Simponi/Simponi Aria)
- infliximab (Remicade)
Interleukin 17 (IL-17) inhibitors
The other type of biologic approved for AS is interleukin 17 (IL-17) inhibitors. These work similarly to the TNF inhibitors. Instead of targeting TNF, they target the IL-17 protein.
The IL-17 biologics approved for AS in the United States are:
- ixekizumab (Taltz)
- secukinumab (Cosentyx)
Depending on your health history, your doctor will help you decide the best biologic for you. There is no single biologic that works for everyone with AS. People respond differently to medications. If one biologic doesn’t help, it’s possible that another will work for you.
Remember though that biologics typically take time before they start working. You might see an improvement in symptoms within a few weeks. More likely, it will be months before you notice any difference in how you feel. Keep in touch with your doctor throughout this process. If your biologic still isn’t working after several months, you might need to try a different one.
It’s also normal to switch to a new biologic after a few years. A biologic can lose its effectiveness after you’ve been using it for a while. Talk with your doctor if you notice that your biologic isn’t working the way it used to. It may be time to try something else.
No, biologics are not a cure for AS. Although they can reduce symptoms and help your quality of life, they will not cure AS.
Exercise and other medications in addition to biologics may be part of your treatment plan.
Treatment goals include:
- reducing pain and inflammation
- improving flexibility
- preventing joint fusion
As with any kind of medication, biologics may produce side effects. Since biologics are given as an injection or infusion, it’s possible to have side effects from the actual infusion or injection. There are also some side effects that occur with ongoing use of biologics.
Infusions are done in a clinic setting. Side effects that can occur from the infusion include:
- redness or pain at infusion site
Before the infusion starts, you may be given medications to prevent side effects. You will also be monitored throughout the infusion.
Injectable biologics can be used at home. You may give your own injection or have someone help you do it.
Side effects of the injection can include:
- pain or itchiness at the injection site
- redness or a rash in the area around the injection site
Beyond those that may occur at the time of the injection or infusion, other side effects are possible.
The most common side effects of either injected or infused biologics are:
- bowel changes, such as constipation or diarrhea
Yes, biologics do lower your immune system because they target specific parts of your system to prevent the inflammatory response.
Changes to your immune system mean your body will also have a harder time fighting off infections. You may be more likely to get a cold, flu, or urinary tract infection. But your AS symptoms should improve.
Here are some ways to take care of yourself when you are on a biologic:
- Wash your hands frequently.
- Limit time in busy, crowded places.
- Avoid contact with people who may be sick.
- Talk to your doctor about recommended vaccines.
- Let your doctor know if you notice any changes in your health.
- Do your best to get enough rest.
- Wear gloves or wash your hands as soon as possible after handling raw pet food or cleaning up pet feces.
- Wash your hands after touching
petreptiles or amphibians, as they can carry harmful Salmonella bacteria.
- Cook your food to a safe temperature to prevent foodborne illness.
There are several biologic medications approved for the treatment of AS. They work to lower the immune response that causes pain, stiffness, and inflammation. They can also help to prevent joints from fusing together.
You may need to try several before you find one that works well for you. As with any therapy, there can be side effects. One of the main effects of biologics is a lowered immune system. There are several things you can do to keep yourself healthy while undergoing treatment for your AS.