Ankylosing spondylitis (AS) is a chronic condition that can cause joint inflammation in your spine. Inflamed spinal joints can gradually fuse together, triggering pain and stiffness in the spine, hip, lower back, and neck. This condition can also lead to rounding of the upper spine and disability.
Over-the-counter (OTC) medications such as naproxen sodium (Aleve) and ibuprofen (Motrin, Advil) may improve milder cases of AS. Some people, however, require a disease-modifying antirheumatic drug (DMARD) for relief and remission. These prescription medications suppress the immune system and reduce inflammation in the body.
Biologics are another option for treating AS. This type of therapy works by targeting specific proteins that trigger inflammation.
Six types of biologics have been approved for the treatment of AS:
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- etanercept (Enbrel)
- golimumab (Simponi; Simponi ARIA)
- infliximab (Remicade)
- secukinumab (Cosentyx)
If you’re not familiar with biologics, you may question whether they’ll work for you.
As with any type of therapy, results aren’t guaranteed. But you can ask yourself a few questions to gauge how your body may respond to biologics.
1. Did other medications provide relief?
Doctors don’t recommend biologic therapy for everyone with AS. Typically, biologics are for people who have moderate to severe AS, if they haven’t responded to other types of treatments.
Biologics are generally not the first line of treatment for this condition. After you’re diagnosed, your doctor may recommend OTC medications to see if they’ll help you manage symptoms. If not, your doctor may then prescribe an immunosuppressant medication or, in rare cases, administer a steroid injection into one of your sacroiliac joints in your pelvis. Both can suppress your immune system, relieve chronic inflammation, and help you achieve remission.
Sometimes AS symptoms can improve with making lifestyle changes. These changes include being more physically active to increase joint flexibility, losing weight to reduce pressure on joints, and learning how to control stress, which can also trigger inflammation in your body.
If nonsteroidal anti-inflammatory drugs (NSAIDs), DMARDs, and lifestyle changes are effective, you may not need biologic therapy. However, if they don’t improve your condition, biologics may work for your AS.
2. Can I keep up with scheduled treatments?
Biologic therapy isn’t available in pill or oral form. Instead, you’ll receive infusions at your doctor’s office a few times a year. Depending on the specific drug, you can also give yourself injections every one to two weeks.
Biologic treatment targets proteins in your body with the purpose of suppressing your overactive immune system and calming your body’s inflammatory response. For this therapy to work, you must keep up with your scheduled injections and infusions. If you stop treatment, your symptoms may resurface.
Keep in mind that biologics aren’t intended to cure AS — there’s no cure for the condition.
3. Will I take other medications with a biologic?
If you’re a candidate for targeted therapy, your doctor may prescribe only a biologic, or you may receive a DMARD to take with your biologic treatment.
Even though biologics are effective for treating AS, some people don’t respond to the treatment alone and need a combination of therapies. You can’t take two biologics at the same time, but it is safe to combine a biologic with an antirheumatic drug.
4. Who shouldn’t take biologics?
Despite the effectiveness of biologics, this type of treatment isn’t right for everyone.
Even though biologics aren’t like traditional immunosuppressants that suppress the entire immune system, they can compromise your immune system and make you more susceptible to illnesses and infections. It also becomes harder to fight infections while taking biologic drugs.
Your doctor may not recommend biologic therapy if you have a weakened immune system: for instance, if you’re being treated for cancer or if you’ve been diagnosed with HIV or hepatitis C.
The immune-suppressing effect of biologics could worsen an existing infection. Therefore, if you have an active infection, you should wait until the infection clears before beginning treatment.
Also, long-term use of biologics may increase the risk of certain cancers, especially lymphoma. After starting a biologic, if you develop a cold or flu that doesn’t improve, or if you experience other symptoms such as bruising, weight loss, or fatigue, make sure to see your doctor.
5. What should I know before taking a biologic?
Because people respond differently to biologics, there’s no way to know if the treatment will work for your AS until after you start.
Biologic therapy isn’t a quick fix for inflammation. Some people see improvement soon after starting therapy, but it may take anywhere from four weeks to three months to notice a significant difference in your condition.
If you take one biologic and don’t see an improvement in your symptoms, don’t give up in your search for relief. Talk with your doctor to see if you’re a candidate for another biologic.
Even if you find a biologic that works for your AS, it could stop working overtime. In that case, your doctor may switch you to another biologic or include an antirheumatic drug with your therapy.
Finding the right combination of drugs can keep your symptoms under control long term and slow the progression of the disease.
Don’t ignore joint pain or stiffness. Consult with your doctor as soon as you notice symptoms and get a diagnosis.
AS can limit mobility and cause ongoing pain, but relief is available. If left untreated, AS can progress and worsen. Although the outlook is positive with treatment, it’s imperative that you find the right biologic and keep up with your scheduled treatments.