New treatments are changing the lives of people with ankylosing spondylitis (AS), an inflammatory form of arthritis in the spine and large joints.
AS still doesn’t have a cure, but new medications and other therapies are getting better at managing symptoms and slowing disease progression.
A few new medications have recently come on the market and more are on the horizon. Researchers are also studying treatments beyond medication, like water and heat therapy, to see their effects on pain, stiffness, and other symptoms.
In the past, AS medications like nonsteroidal anti-inflammatory drugs (NSAIDs) could only relieve pain and other symptoms. Newer medications actually slow the disease to prevent joint damage.
TNF inhibitors were the first new group of biologic drugs to come along for AS. They work by blocking inflammatory chemicals called cytokines in your body.
Five TNF inhibitors are approved by the Food and Drug Administration (FDA) for AS:
- adalimumab (Humira)
- certolizumab (Cimzia)
- etanercept (Enbrel)
- infliximab (Simponi)
- golimumab (Remicade)
Your doctor might prescribe one of these medications if NSAIDs haven’t managed your pain and inflammation well. Like other biologic drugs, TNF inhibitors can increase your risk of infection because they suppress your immune system.
IL-17 inhibitors like ixekizumab (Taltz) and secukinumab (Cosentyx) work to block another type of inflammatory cytokine called interleukin-17. Taltz is the newest IL-17 inhibitor. It’s been approved since 2019.
Because these drugs target a different cytokine, they could help people whose AS didn’t improve with TNF inhibitors. Infections are also a side effect of this group of medications.
Bimekizumab is the first IL-17 inhibitor to target two cytokines at once: IL-17A and IL-17F. A late-stage study called BE MOBILE 2 showed promising results with bimekizumab. Many study participants had an improvement of 40 percent or more in their symptoms.
Tofacitinib (Xeljanz, Xeljanz XR) is the first in a group of drugs called Janus kinase (JAK) inhibitors approved for AS. It’s also the first new pill for AS since NSAIDs. JAK inhibitors block the signals that cause inflammation.
Xeljanz is for people who have tried one or more TNF inhibitors without seeing an improvement in their symptoms. It comes as a pill that you take twice a day, or as an extended-release version that you take once daily.
Another new JAK inhibitor, upadacitinib (Rinvoq), was submitted to the FDA for approval in 2022. A
A new JAK inhibitor called LNK01001 is in a clinical trial. The study will show whether this new drug is a safe and effective treatment for AS.
Inside our gut is a miniature city that’s full of bacteria and other tiny organisms. Scientists call this our microbiome. A growing number of studies show that problems with the microbiome might trigger AS and worsen it.
According to a 2021 observational study, up to 60 percent of people with AS have inflammation in their gut, and up to 10 percent also develop inflammatory bowel disease.
Researchers looked at the effects of the TNF inhibitor adalimumab (Humira) on the microbiome of 30 people with AS. After 6 months of treatment, Humira helped restore the microbiome to a more normal state in many study participants.
In participants whose microbiome changed, Humira also improved AS symptoms. Researchers said the microbiome might one day be a tool to help doctors predict who will respond to treatment and who won’t.
Medication is an important part of AS treatment. A few other nondrug therapies are also key to reducing symptoms and improving function.
In this treatment, you work with a physical therapist who evaluates your needs and designs a program for you. Physical therapy can include exercise, heat, cold, electrical stimulation, and hands-on techniques.
Exercising in water has advantages for people with arthritis. The buoyancy of the water takes stress off painful joints, while the warmth feels soothing.
Water therapy not only relieves pain, but it slows the disease,
This treatment applies very high heat to your whole body or to certain parts of your body. Hyperthermia is a treatment for conditions ranging from cancer to arthritis. It’s thought to work in AS by helping to suppress inflammation.
Research on hyperthermia for AS is still early but promising. In one small 2018 study, whole-body hyperthermia reduced the number of cytokines in the blood by
Treatment options for AS are improving, with more options that help slow disease progression in addition to delaying the pain. Beyond medication, techniques like physical therapy, water therapy, and hyperthermia are helping people with AS manage their symptoms.
If you’d like to try one of these new treatments, talk with the doctor who treats your AS. Ask about enrolling in a clinical trial. It could give you access to a new therapy before it’s available to everyone else.