Medication

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Anti-inflammatory painkillers

'Anti-inflammatories' are used to ease a flare-up of symptoms. They reduce inflammation, and ease pain. However, they do not alter the course of the disease. An important part of these drugs is to ease pain so that you can do regular exercises without much discomfort. There are several different brands of anti-inflammatory painkillers. For example, ibuprofen, diclofenac and naproxen - but there are many others. If one does not suit, another may be fine. Side-effects sometimes occur with these drugs. For example:

Stomach pain and bleeding from the stomach are the most serious. The risk of this is higher if you are over 65, or have had a duodenal or stomach ulcer. Stop taking the drug and see a doctor if you develop stomach or abdominal symptoms.
You may not be able to take anti-inflammatory painkillers if you have asthma, high blood pressure, kidney failure, or heart failure.

Ordinary painkillers

Painkillers such as paracetamol may be sufficient if symptoms are mild between flare-ups. You can also taker paracetamol in addition to an anti-inflammatory for top-up pain relief.

Immunosuppressant drugs

Newer powerful drugs have become available in recent years that suppress the immune system. These have made an impact on the treatment of AS. They tend to be divided into two groups, biological therapies and immunomodulators.

Biological therapies: These are genetically engineered proteins such as special antibodies called monoclonal antibodies. They can target specific chemicals of the immune system involved in the inflammation process. In AS, a chemical called cytokine tumour necrosis factor alpha (TNF-alpha) is involved in the inflammation process. Certain drugs in a group called TNF-alpha antagonists (which are really manufactured antibodies) block the action of this chemical and therefore suppress the disease activity. TNF-alpha antagonists include etanercept, adalimumab and infliximab. Treatment with one of these drugs is an option in some cases. These drugs need to be given by injection every 1-6 weeks depending of the dose and type and require special monitoring as some people develop serious side-effects. For example, taking these drugs can make you more prone to develop a serious infection. A specialist may advise using one of these drugs if you have moderate or severe AS which has not been helped much by anti-inflammatory drugs.

Regarding TNF antagonists, recent national guidelines from the National Institute for Health and Clinical Excellence (NICE) states:

"Adalimumab or etanercept are recommended as possible treatments for people with severe ankylosing spondylitis who:

* have active spinal disease as assessed on two occasions 12 weeks apart, and
* have tried at least two non-steroidal anti-inflammatory drugs (NSAIDs) but they have not worked.

Treatment should be started and supervised by a specialist who is experienced in diagnosing and treating ankylosing spondylitis. People taking adalimumab or etanercept should have regular check-ups. Treatment should continue only if the person's ankylosing spondylitis shows an adequate improvement. If the improvement is not maintained or if the drug stops working then treatment should be stopped. Infliximab is not recommended."

Immunomodulators: These are drugs that modify and suppress the immune system. They include sulphasalazine and methotrexate. (These drugs are commonly used to treat people with rheumatoid arthritis - a different type of arthritis.) One may be tried in people with severe AS where other treatments have not helped much. Research continues to clarify their role in AS. However, as a rule, research studies suggest that they do not work as well in AS as they do in rheumatoid arthritis. People who take these drugs need careful monitoring as there is a risk from serious side-effects. For example, taking these drugs can make you more prone to develop a serious infection. A specialist can advise on the up-to-date research relating to these drugs and if one should be used.