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.
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 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.
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 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.
Where to Go For Assistance with Medical and Prescription Costs
Managing the costs associated with healthcare of spondylitis 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: "The majority of commercially insured HUMIRA patients are eligible* to pay $5 or less for HUMIRA with this savings card."
- 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."
- ENcourage 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)
- Rebate and Prescription Assistance programs for REMICADE
From the site: "This page has information about prescription assistance programs sponsored by relevant Janssen Pharmaceutical Companies as well as up-to-date information about independent foundations that may have available funding to help minimize drug costs for REMICADE®."
Patient assistance programs for SIMPONI (Golimumab)
- Savings Cards and Prescription Assistance programs for SIMPONI
From the site: "Information about prescription assistance programs sponsored by relevant Janssen Pharmaceutical Companies as well as up-to-date information about independent foundations that may have available funding to help minimize drug costs for SIMPONI®."
Other Patient Assistance programs and Drug Discount Cards (could include discounts for TNF-a inhibitors as well)
- Chronic Disease Fund
Their focus is to provide assistance to those under-insured patients who are diagnosed with chronic or life altering diseases that require the use of expensive, specialty therapeutics.
- 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. Please click here for more information on how to use this card, and please click here to download a copy of the card.
- HealthWell Foundation
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."
- Merck Helps
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."
*Also note that SAA and Needy Meds have partnered to offer a Drug Discount Card. More information, as well as the card can be found at the below url: www.spondylitis.org/pdf/needymeds-card.pdf
- Patient Access Network Foundation
Toll Free (866) 316-PANF (7268)
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 (444-2669)
From the site: "The Partnership for Prescription Assistance brings together America's pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that's right for them."
- Patient Advocate Foundation Co-Pay Relief
Toll Free (866) 512-3861
From the site: "Patient Advocate Foundation's Co-Pay Relief (CPR) Program provides direct co-payment assistance for pharmaceutical products to insured Americans who financially and medically qualify."
- Pfizer Helpful Answers
From the site: "Pfizer Helpful Answers family of patient assistance programs offers different services to match the unique needs of each patient."
- RxAssist Patient Assistance Program Center
From the site: "RxAssist is a website with information, news, and a database that are all designed to help you find out about ways to get affordable, or free, medications. The database includes information on the pharmaceutical companies' patient assistance programs, or programs that provide free medication to low-income patients. RxAssist was created by Volunteers in Health Care, a national, nonprofit resource center for healthcare programs working with the uninsured."
Toll Free (877) 979-4673
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."
- Rx Outreach
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 the leading provider of professional pharmaceutical services and patient assistance programs. Our patient assistance programs in partnership with leading providers of pharmaceutical care providers offers low cost medications for virtually all brand or generic medications. Our innovative program provides pharmaceutical services to qualified individuals for as low as $20 for a 3 months supply of medication."