How medicines fit in

There are a range of treatments available for ankylosing spondylitis, the treatment prescribed will depend on each person's condition. These treatments may help to:

• Relieve painful symptoms
• Slow down how quickly the disease develops
• Reduce fatigue
• Maintain mobility

Generally, treatment for ankylosing spondylitis comes as a combination of physical therapy such as special exercises, and medication.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs, or NSAIDs as this group of drugs are often called, are usually the first treatment you are given for your ankylosing spondylitis.

• Traditional NSAIDs

There are a number NSAIDs - such as Ibuprofen - that reduce pain by calming inflammation.  NSAIDs work by blocking the activity of the enzyme involved in inflammation, cyclooxygenase, also known as COX.  Traditional NSAIDs are widely prescribed in the UK and are often the first choice for doctors; however, they are linked with stomach-related side effects including indigestion, ulcers as well as other more serious complications.

• COX-2 selective inhibitors

Studies have shown that there are two forms of COX, simply known as COX-1 and COX-2.  COX-2 is more closely linked with inflammation, where as COX-1 is more closely associated with tissue repair.  By predominantly targeting COX-2, these medications provide pain relief without hindering the actions of COX-1.  As a result, studies have shown that there are less stomach-related side effects associated with COX-2 selective inhibitors compared to NSAIDs.

By reducing inflammation, NSAIDs can help to control pain and joint stiffness. This group of drugs are more effective in relieving peripheral symptoms (such as those affecting joints of fingers, wrists, hips and ankles) and may have a limited effect on spinal symptoms.

There are a number of different NSAIDs available. People's responses to NSAIDs vary, so more than one NSAID may be tried before one that works best for you is found. NSAIDs generally come in tablet or capsule form and are usually taken by mouth.

Some patients with heart conditions are not suitable for all NSAIDs.  Your doctor will consider the benefits versus the risk before recommending a treatment.

Disease modifying anti-rheumatic drugs (DMARDs)

Disease modifying anti-rheumatic drugs, or DMARDs as they are also known, are a type of medication that may be prescribed to treat the peripheral symptoms of ankylosing spondylitis. Examples of DMARDs include sulfasalazine and methotrexate and they may also be prescribed at the same time as an NSAID.

These drugs might have positive effects on ankylosing spondylitis symptoms in some people. It can take a number of months for these drugs to work and they are not usually chosen as a first treatment for ankylosing spondylitis.

DMARDs are generally taken by mouth, but some forms can be given via a subcutaneous injection (an injection just under the skin).
Close monitoring by your healthcare professional is required while you are on some DMARDs, which may include regular blood tests.

Potential side effects of DMARDs include diarrhoea, nausea, skin rash, mouth sores, changes to liver function and hair loss. As side effects are specific to individual treatments, it is important to check the patient information leaflet for any medication you use or talk to your healthcare team.

People taking DMARDs will often be provided with a patient held monitoring card to be carried at all times

Anti-TNF therapies (a type of biologic therapy)

Anti-TNF (anti-tumour necrosis factor) therapies may be prescribed to people with severe active ankylosing spondylitis (by their rheumatologist) if other therapies have failed or are unsuitable.

These therapies target part of the immune system that is responsible for causing an excessive inflammatory response in ankylosing spondylitis, they act by re-balancing this response.

There are a number of available anti-TNF therapies used to treat ankylosing spondylitis. If these are prescribed, a healthcare professional will discuss the different options available to help find the best therapy for you. The healthcare professional will also give you information about the benefits and side effects and discuss any increased risks associated with the different anti-TNF therapies available.

Anti-TNF therapies are taken either by subcutaneous injection (an injection just under the skin) or by intravenous infusion (via a needle into a vein). Taking anti-TNF therapy can help to improve ankylosing spondylitis symptoms such as:

• Joint pain and stiffness
• Joint swelling and flexibility
• Fatigue

The most common side effect of these therapies is a reaction at the site where the injection or infusion is given e.g. redness, swelling or infection etc. Some people can also experience an allergic reaction at the beginning of treatment and may be given other medication to reduce this effect. Because anti-TNF therapies act on the immune system you could be more likely to get an infection while on this treatment and even for some months after stopping it.

Things to consider

Taking medicine for ankylosing spondylitis can make a big difference to your quality of life, so it is important that you discuss this with your doctor. You need to be absolutely clear about how you should take it, what to expect and any possible side effects. If you are using non-prescription medicines, such as everyday painkillers, it's important to read the information leaflet in the packet and to discuss these with your doctor, especially if you are taking them regularly.

The inflammation and pain of ankylosing spondylitis can come and go and you may find that there are times when you're feeling good and don't think you need to take your medicine. It's important to remember that, unless otherwise indicated, your doctor has prescribed the medicine for a reason and you should not stop taking it without discussing it with him or her first.

Planning a family

There are some things that you should consider when planning a family:

For women:

• It is important that you tell your doctor if you plan to become pregnant, as it may affect what ankylosing spondylitis treatments you are able to take.
• You must tell your doctor if you are breastfeeding, as this may also affect the treatments you are taking.
• If your hip joints are badly affected, it may be advisable to discuss delivery options when the time comes.

For men:

It is equally important that you tell your doctor if you plan to father a child, as this could affect the ankylosing spondylitis treatment you are able to take.