Medications Used To Treat Ankylosing Spondylitis And Related Diseases
There are a number of different types of medications that have been found to be effective in managing the symptoms of ankylosing spondylitis and related diseases. Note that different people respond to different medications with varying levels of effectiveness. Thus, it may take time to find the most effective medication for treating someone with spondylitis. Click on the image to the right for a quick list. The listing comes from our book, Straight Talk On Spondylitis
, which also has a detailed section on medications.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are the most commonly used class of medication used in treating the pain and stiffness associated with spondyloarthritis. For example, Ibuprofen is a generic NSAID and is found in over-the-counter pain relievers such as Advil and Motrin. They commonly come in tablet form and are taken orally.
Sometimes high doses of NSAIDs are needed to maintain relief from the symptoms of ankylosing spondylitis and related diseases. This can pose a problem in that NSAIDs can cause significant side effects, especially in the gastrointestinal tract (stomach, intestines, etc.) NSAIDs can cause reduction in the protective mucus in the stomach, which can cause stomach irritation. In time, this can lead to heartburn, gastritis as well as ulcers and even bleeding. People can take other medications (such as antacids) to neutralize or prevent the production of excess stomach acid, take drugs to help coat and protect the stomach (such as Carafate), or take medication to help restore the lost mucus (such as Cytotec, ).
A different class of NSAIDs known as COX-2 inhibitors (or COXIBs) allegedly reduce the risk of gastrointestinal complications associated naproxen with traditional NSAID therapy. Celebrex (Celecoxib) is still being used to treat spondyloarthritis. Others, such as Vioxx, were pulled from the market because of potential cardiac side effects.
When NSAIDs Are Not Enough?
Although NSAIDs are commonly the first line of medications used to treat ankylosing spondylitis and related diseases, sometimes they aren't enough to control the symptoms. It is important to note, however, that it may take several weeks for some NSAIDs to show positive results. If you are considering changing medications, remember to ask your doctor about the potential benefits and side effects before you and your doctor decide whether the change in treatment is right for you.
In severe cases of ankylosing spondylitis or related disease, NSAIDs may only be partially effective or the side effects too severe to continue their use. In this case, a doctor may prescribe one of the following medications.
Sulfasalazine is one type of medication that can be helpful to some people with severe disease. It is known to effectively control not only pain and joint swelling from arthritis of the small joints, but also the intestinal lesions in inflammatory bowel disease. It comes in tablet form and is taken orally.
Side effects are relatively infrequent, but can include headaches, abdominal bloating, nausea and oral ulcers. Rarely, someone being prescribed this medication can develop bone marrow suppression, which is why it is important for your doctor to regularly monitor your blood count.
Originally developed to treat cancer, this chemotherapy drug is widely used and often very effective for the treatment of rheumatoid arthritis. When prescribed for treating ankylosing spondylitis, it is given in much smaller doses. Methotrexate can either be taken via a self-injectable shot, or orally in tablet form. When taking methotrexate, it is also necessary to take the vitamin folic acid in order to help suppress possible side effects.
Oral ulcers and nausea are the most common side effects, but can be minimized by taking folic acid. Because of other potential serious side effects, the frequent monitoring of blood counts and liver tests are required.
Corticosteroids such as prednisone can be effective in relieving the inflammation of AS, but the side effects of long-term use can be very severe. Corticosteroid injections into the inflamed joints can provide temporary relief of the pain caused by arthritis or bursitis. In instances of Achilles' tendonitis, such injections are rarely, if ever used because of the risk of rupturing the Achilles tendon. Also, the usefulness of corticosteroid injections to relieve the symptoms of plantar fasciitis (heel pain) is not clear. More information on corticosteroids can be found at Medline Plus.
The Biologics: TNF Inhibitors
The Tumor-Necrosis-Factor alpha (TNF-a) blockers are biologic medications that have shown great promise in treating ankylosing spondylitis. They have been shown to be highly effective in treating not only the arthritis of the joints but the spinal arthritis associated with ankylosing spondylitis and related diseases.
The most serious known side effect of the TNF blockers is an increased frequency of infections, especially tuberculosis. Thus, a TB test is usually required before starting any of the TNF therapies. A very rare possible complication is increased frequency of cancer, especially of the blood (leukemia) or of the lymphatic system (lymphoma).
It should be noted that each TNF-a Inhibitor / Biologic medications works in a slightly different manner. Thus, if one does not have a positive effect, another one might.
IL 17 Inhibitors
Both IL 17 and TNFa are inflammatory cytokines (cell signaling molecules) that, as the name implies, signal to activate inflammation throughout the body, modulating or altering the immune system response. Inflammatory cytokines play an important role; however, when there is an overabundance of these, as has been described in inflammatory disease, they can cause harm to the body if left unchecked.
The first IL 17 inhibitor was approved on January 16, 2016 for ankylosing spondylitis (AS) and active psoriatic arthritis (PsA): Cosentyx® (secukinumab). Click here for Patient Information >>>
Where to Go For Assistance with Medical and Prescription Costs*
Managing the costs associated with spondyloarthritis can be stressful, and for many a financial burden. Below is a list of assistance programs that can help with the cost of medications, co-pays, and other healthcare needs.
*SAA does not endorse or recommend any medications or products for spondylitis, and always advises that you seek the counsel of a physician before initiating any treatment for spondylitis.
Patient assistance programs for HUMIRA (Adalimumab)
HUMIRA Protection Plan
From the site: "With the HUMIRA Co-pay Savings Card, the majority of commercially insured HUMIRA patients are eligible to pay as little as $5 a month for each HUMIRA prescription."
The AbbVie Patient Assistance Foundation
From the site: "The AbbVie Patient Assistance Foundation provides AbbVie medicines at no cost to qualified patients who are experiencing financial difficulties and who generally do not have coverage available for these products through private insurance or government funded programs."
Patient assistance programs for ENBREL (Etanercept)
Enbrel Support Card
From the site: "The ENBREL Support™ card provides financial support to eligible* commercially insured patients when presented to the pharmacy."
The Safety Net Foundation
From the site: "ENcourage Foundation® is a nonprofit patient assistance program supported by Amgen and Pfizer that provides Enbrel® (etanercept) at no cost to qualifying patients with no or limited drug coverage."
Patient assistance programs for REMICADE (Infliximab)
Janssen CarePath and Other Savings Programs for REMICADE®
(877) CarePath (877-227-3728)
From the site: "Here you'll find the medication assistance programs available for REMICADE®. We have also listed most of the eligibility requirements.”
Patient assistance programs for SIMPONI (Golimumab)
Janssen CarePath and Other Savings Programs for SIMPONI®
(877) CarePath (877-227-3728)
From the site: “Here you'll find the medication assistance programs available for SIMPONI®. We have also listed most of the eligibility requirements.”
Patient assistance programs for CIMZIA (Certolizumab Pegol)
CIMZIA Co-Pay Savings Program
From the site: "At UCB, we offer CIMZIA cost savings for eligible patients regardless of income through the CIMZIA Co-Pay Savings Card."
Patient assistance programs for COSENTYX (Secukinumab)
Cosentyx Connect Personal Support Program
From the site: "The COSENTYX Connect Personal Support Program offers a range of helpful resources and tools, available whenever you need them, 24/7."
Other Patient Assistance programs and Drug Discount Cards (May include additional discounts for biologics.)
Drug Discount Card
SAA has partnered with NeedyMeds to provide a Drug Discount Card for prescription medications. Anyone can use this card, but it cannot be combined with insurance, Medicare or Medicaid. Download the Drug Discount Card
(Formerly known as Chronic Disease Fund)
From the site: "We help patients suffering from chronic medical conditions who have limited financial means get access to the medications they need. Our program helps qualified patients pay their insurance co-pays so they can get immediate access to prescription medications that will give them relief from pain and suffering."
From the site: "Use GoodRx's drug price search to compare prices (just like you do for travel or electronics on other sites) for your prescription at pharmacies near you. We don't sell the medications, we tell you where you can get the best deal on them."
From the site: "A nonprofit, charitable organization that helps individuals afford prescription medications they are taking for specific illnesses. The Foundation provides financial assistance to eligible patients to cover certain out-of-pocket healthcare costs, including: prescription drug coinsurance, co-payments, and deductibles, health insurance premiums, and other selected out-of-pocket healthcare costs."
From the site: "At Merck, we believe that no one should go without the medicines or vaccines they need. That is why the Company provides its medicines and adult vaccines for free or at discounts to people who do not have prescription drug or health insurance coverage and who, without our assistance, cannot afford their Merck medicine and vaccines."
From the site: "NeedyMeds is a source of information about assistance programs that help with the cost of medicine and other healthcare expenses."
NeedyMeds also offers a searchable database of Free/Low-Lost Medical Clinics
Patient Access Network Foundation
(866) 316-PANF (7263)
From the site: "The Patient Access Network Foundation is a nonprofit 501(c)(3) organization dedicated to supporting the needs of patients that cannot access the treatments they need due to out-of-pocket healthcare costs."
Partnership for Prescription Assistance
Toll Free (888) 4PPA-NOW
From the site: "The Partnership for Prescription Assistance helps qualifying patients without prescription drug coverage get the medicines they need for free or nearly free."
They also offer a searchable database of Free/Low-Cost Clinics
Patient Advocate Foundation Co-Pay Relief
Toll Free (866) 512-3861
From the site: "PAF Co-Pay Relief (CPR) provides direct financial assistance to qualified patients, assisting them with prescription drug co-payments their insurance requires relative to their diagnosis. CPR call counselors work directly with the patient as well as with the provider of care to obtain necessary medical, insurance and income information to advance the application in an expeditious manner."
From the site: "Pfizer RxPathways is a comprehensive assistance program that provides eligible patients with a range of support services, including insurance counseling, co-pay assistance,* and access to medicines for free or at a savings."
RxAssist Patient Assistance Program Center
From the site: "Patient assistance programs are run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine. RxAssist offers a comprehensive database of these patient assistance programs, as well as practical tools, news, and articles so that health care professionals and patients can find the information they need. All in one place."
From the site: "You can apply here for Patient Assistance Programs offered by hundreds of manufacturers, as well as find information on programs offered by State and Federal government and by pharmaceutical companies."
From the site: "Rx Outreach is a patient assistance program (PAP) for people of all ages. The program makes prescription medicines affordable for uninsured and under-insured individuals and families."
Together RX Access
From the site: "The Together Rx Access™ Card was created as a public service by a group of some of the world's largest pharmaceutical companies, in order to provide savings on prescriptions to eligible residents of the US and Puerto Rico who have no prescription drug coverage."
From the site: "We are a comprehensive pharmacy services company with the mission to be your leading source for affordable medications. We have helped tens-of-thousands of patients just like you save hundreds on their prescription medication cost through our Patient Assistance Program."