Ankylosing spondylitis (AS) is a chronic autoimmune disease that primarily affects the spinal joints, but large joints, such as the hips and shoulders, can also be involved.
Inflammation, resulting from the immune system activity, causes joint fusing in sections of the spine, which often leads to pain, swelling, and stiffness.
This can limit mobility, making it difficult to complete everyday tasks.
There’s no cure for this disease, but different treatments can slow the progression and help you live an active life. Your healthcare provider will develop a treatment plan for you after your diagnosis.
Because symptoms of AS can range from mild to severe, some people can manage their symptoms with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) and naproxen sodium (Aleve).
If your symptoms don’t respond to those drugs, prescription medications are the next line of defense.
Prescription drugs used for AS include disease-modifying anti-rheumatic drugs (DMARDs) to decrease the inflammation immune activity causes.
Although they’re unable to target the exact cause of it, NSAIDs and DMARDs are both designed to stop inflammation.
Sometimes the pain and stiffness AS brings about doesn’t respond to these prescription medications. To help you manage symptoms, your doctor may recommend a different type of therapy called biologics.
Biologics are genetically engineered proteins created from living organisms that mimic normal biological functions.
They’re targeted therapies aimed at specific proteins in the immune system that produce inflammation, namely:
- tumor necrosis factor (TNF)
- interleukin 17 (IL-17)
The Food and Drug Administration (FDA) approved the first biologic in 1988 to treat rheumatoid arthritis. Since then, several other biologics have been developed.
Currently, seven types of biologics are approved for the treatment of AS. These include:
1. Tumor necrosis factor (TNF) blockers
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- etanercept (Enbrel)
- golimumab (Simponi, Simponi Aria)
- infliximab (Remicade)
2. Interleukin 17 (IL–17) inhibitors
- secukinumab (Cosentyx)
- ixekizumab (Taltz)
Biologics must be delivered into tissue just under the skin or deep into muscle. They’re not available in pill or oral form. You receive them through injections or infusions.
The frequency of injections or infusions needed will vary depending on the particular biologic therapy.
You may receive an infusion every few months. Or, you may require multiple starter injections and then follow-up injections throughout the year.
For example, the biologic Simponi requires three starter injections:
- two injections on the first day of treatment
- one injection 2 weeks later
Afterward, you’ll give yourself one injection every 4 weeks.
On the other hand, if you take Humira, you’ll give yourself one injection every other week after four starter doses.
Your doctor will tell you how often you’ll need biologic therapy, and they’ll give you instructions on how to administer your injections.
Biologics don’t improve symptoms of AS overnight, but you should begin to feel better in about 4 to 12 weeks, sometimes sooner.
The goal of treatment is to suppress your symptoms so that the condition doesn’t interfere with your life. It’s important to note that biologics won’t cure AS.
Biologics are often effective, but they’re very expensive in the United States. On average, the cost of biologics are
Insurance will likely cover part of the costs, though it will depend on your coverage.
Talk to your doctor about options for biosimilars (similar formulations to biologics) and any patient assistance programs through drug manufacturers.
There’s the risk of side effects or allergic reactions with many types of medications, and biologics are no exception.
Side effects of biologic therapy can include:
- pain, redness, rash, or bruising at the injection site
- headache
- hives or rash
- stomach pain
- back pain
- nausea
- cough or sore throat
- fever or chills
- difficulty breathing
- low blood pressure
These side effects are usually mild and will typically subside and eventually go away.
However, you should call your doctor if you have symptoms such as hives, swelling, or difficulty breathing. These could be signs of an allergic reaction.
Because biologics suppress your immune system, they can increase your risk for infections and cancer.
Your doctor may order lab tests prior to your first injection or infusion to check for:
- tuberculosis
- hepatitis B and C
- other infections
See your doctor if you develop signs of an infection after beginning treatment, such as:
- fever
- chills
- shortness of breath
- coughing
Also, notify your doctor if you have unexplained:
- bruising
- weight loss
- unusual tiredness
Biologics may increase the risk of developing blood cancers such as lymphoma.
Although all biologics for AS are intended to slow the progression of the disease and stop inflammation, biologics don’t work the same for everyone.
If you begin biologic treatment, your doctor may start you off with one type and monitor your condition over the next 3 months to see if there’s any improvement.
Don’t feel discouraged if your symptoms don’t lessen after your initial infusions or injections. If your AS doesn’t improve, your doctor may suggest switching to a different biologic approved for AS.
Biologic therapy alone isn’t the only option.
You shouldn’t take more than one biologic at a time due to the risk of infection, but you can take biologics with other medications for AS. Finding relief from AS is sometimes a matter of trial and error.
Be patient. It may take time to find the right combination of drugs.
For instance, though your symptoms didn’t improve while taking NSAIDs or DMARDs, combining a biologic with these medications may be effective.
Without proper treatment, AS can gradually progress and cause increased pain, stiffness, and limitation of movement.
Talk to your doctor if you feel that your current therapy isn’t working. You might be a candidate for biologics.
But before starting biologic treatment (as with any treatment), make sure you know your options and ask questions.