Ankylosing spondylitis is an inflammatory condition that causes pain and stiffness in the spine’s joints. Over time, it can progress to fusing the bones of the spine/vertebrae, limiting the spine’s mobility and leading to discomfort symptoms. The condition is more common in men but also affects women. There is not a known, singular cause, but individuals with a particular gene, HLA-B27, have an increased risk of developing the condition. However, the gene itself does not mean an individual has ankylosing spondylitis; genetics and other outside and environmental factors also play a role. DMARDs, or Disease-Modifying Antirheumatic Drugs, suppress inflammation. An emerging DMARD treatment uses biologics that further target and suppresses specific inflammatory compounds.

Biologics

Unlike regular medications, which are synthesized, biologics are made from and inside living sources.

• They are grown in cultures or harvested from blood.
• Biologics are complex and expensive.
• Biologics provide some of the most powerful treatments for many conditions.
• Two biologics commonly used to treat ankylosing spondylitis are:
• TNF inhibitors.
• IL-17 inhibitors.

TNF Inhibitors

• TNF – tumor necrosis factor, TNF inhibitors are a biological medication that targets and suppresses TNF, which is involved in inflammatory processes throughout the body.
• Blocking or suppressing TNF decreases inflammation and can delay the progression of ankylosing spondylitis.
• It could be administered through an injection or infusion to provide the medication.

Side Effects

Side effects associated with this medication, along with other conditions, include:

• Skin irritation – rashes or infections
• Heart failure
• Lupus
• Lymphoma
• Disorders that target the neurological system are known as demyelinating disorders. These can include conditions such as:
• Multiple sclerosis
• Guillain-Barré Syndrome

IL-17 Inhibitors

• IL – interleukin – IL-17 is a protein involved in inflammatory processes and conditions.
• IL-17 inhibitors suppress inflammation which are newer medications that have been shown to benefit those with ankylosing spondylitis.
• Doctors often administer IL-17 inhibitors through an injection.

Side Effects

Minor side effects include:

• Headaches
• Runny nose
• Irritation at the injection site.

More serious side effects include:

• Certain cancers
• Severe infections
• High blood pressure

Other Treatments

Treatment goals for ankylosing spondylitis include:

• Slowing the disorder’s progression.
• Decreasing inflammation.
• Reducing pain.
• Improving or maintaining joint and spinal range of motion.

Biologics are not the first-line treatment for ankylosing spondylitis.

• Providers usually first treat an initial diagnosis with anti-inflammatory medications, like NSAIDs, to decrease inflammation and slow the condition’s progression.
• Chiropractic care and physical therapy are recommended to maintain and/or improve posture, muscle strength, and endurance.
• Recommended lifestyle and nutritional modifications.
• Posture training stretches and exercises.
• Optimal movement strategies to safely and confidently complete everyday tasks.

Biologic Medications

Biologics for ankylosing spondylitis may or may not be suitable. These medications are meant to help relieve the inflammation associated with the condition and slow the disorder’s progression. Your healthcare team will work with you to determine the right treatment option/s and explain the benefits, risks, and types of treatment. They will monitor the condition, track progress, and adjust the plan accordingly.

---

Assessing Hormone Therapy

---

References

Ankylosing spondylitis. (n.d.) National Institute of Arthritis and Musculoskeletal and Skin Diseases. U.S. Department of Health and Human Services. Available at: www.niams.nih.gov/health-topics/ankylosing-spondylitis#:~:text=Ankylosing%20spondylitis%20is%20a%20type,the%20spine%20can%20cause%20stiffness (Accessed: October 12, 2022).

Chen C, Zhang X, Xiao L, Zhang X, Ma X. Comparative Effectiveness of Biologic Therapy Regimens for Ankylosing Spondylitis: A Systematic Review and a Network Meta-Analysis. Medicine (Baltimore). 2016 Mar;95(11):e3060. doi: 10.1097/MD.0000000000003060. PMID: 26986130; PMCID: PMC4839911.

Gerriets V, Goyal A, Khaddour K. Tumor Necrosis Factor Inhibitors. [Updated 2022 July 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK482425/

Lindström, U., Olofsson, T., Wedrén, S. et al. Biological treatment of ankylosing spondylitis: a nationwide study of treatment trajectories on a patient level in clinical practice. Arthritis Res Ther 21, 128 (2019). doi.org/10.1186/s13075-019-1908-9

Yin, Y., Wang, M., Liu, M. et al. Efficacy and safety of IL-17 inhibitors for the treatment of ankylosing spondylitis: a systematic review and meta-analysis. Arthritis Res Ther 22, 111 (2020). doi.org/10.1186/s13075-020-02208-w