Individuals with ankylosing spondylitis have a new treatment option that was previously used for rheumatoid arthritis. It is a medication that belongs to a class known as JAK inhibitors. Ankylosing spondylitis combines joint pain with reduced mobility. Ankylosing spondylitis is different because in severe cases, the bones in the spine can fuse together, literally reducing mobility.

The disease typically begins with pain and stiffness in the back. This is usually after some time of inactivity. Symptoms start before the age of 45 and develop gradually. There is no cure for ankylosing spondylitis but there are treatments that can improve symptoms and put the condition into remission. Ankylosing spondylitis treatment is the most successful when addressed early before irreversible damage to the joints begins.

Janus Kinase Inhibitors

Janus kinase inhibitors have traditionally been used to treat:

• Rheumatoid arthritis
• Psoriatic arthritis
• Ulcerative colitis

The medication works by decreasing the immune system’s activity. Janus kinase inhibitor drugs affect several cellular compounds that are important in the development and progression of ankylosing spondylitis. Currently there are only three Janus kinase inhibitor medications available in the United States and FDA-approved to treat rheumatoid arthritis:

• Xeljanz
• Rinvoq
• Olumiant
• Each of the approved inhibitors targets specific enzymes

Current Ankylosing Spondylitis Treatments

Janus kinase inhibitors are not given to individuals right away. However, it could be an option if first and second-line treatments are not working. Treatments usually consist of:

First Line Treatments

NSAIDs

Nonsteroidal anti-inflammatory medications are the most commonly used to treat ankylosing inflammation, pain, and stiffness.

Chiropractic

Chiropractic physical therapy is a major part of ankylosing spondylitis treatment keeping the spine flexible and as healthy as possible. A chiropractic/physical therapy team design and develop specific exercises to fit individual needs, which include:

• Stretching and Range-of-motion exercises help maintain flexibility in the joints
• Sleeping and walking posture adjustment exercises
• Abdominal and spinal exercises to maintain a healthy posture
• Strength training

Second-Line Therapies

If nonsteroidal anti-inflammatory medications do not relieve symptoms, then biological medications could be prescribed. This class of medications includes:

• Tumor necrosis factor blockers
• Interleukin-17 inhibitors

Tumor Necrosis Factor

Tumor necrosis factor blockers work by targeting cell protein that is part of the immune system, known as tumor necrosis alpha. This protein causes inflammation in the body, and the blockers suppress it.

Interleukin 17 Inhibitors

Interleukin 17 in the body’s immune system defends against infection. It uses an inflammatory response to fight infections. The IL-17 inhibitors suppress the inflammatory response and help reduce symptoms.

Other Treatment Options

Lifestyle Adjustments

Following a medical treatment plan is often combined with diet and lifestyle adjustments that are recommended to help with the condition, these include:

• Being as physically active as possible will help:

1. Improve/maintain a healthy posture
2. Maintain flexibility
3. Ease pain

• Applying heat and ice will help alleviate:

1. Pain
2. Stiffness
3. Swelling

• Practicing posture exercises

Surgery

Most individuals with ankylosing spondylitis do not require surgery. However, a doctor could recommend surgery if there is joint damage, the hip-joint needs to be replaced, or if the pain is severe.

JAK Inhibitor Potential

Studies are ongoing in the treatment of ankylosing spondylitis. The drug is currently in Phase 3 trials for the treatment of adults. The trial results have shown patients with active ankylosing spondylitis showed improvement in:

• Fatigue
• Inflammation
• Back pain

The study enrolled adults with active ankylosing spondylitis who took at least two NSAIDs that were ineffective at treating symptoms. Most of the participants were men, average age of 41, and no prior usage of biologic disease-modifying antirheumatic drugs.

Janus kinase could become a standard treatment

There is still not enough research to make a prediction, but the data is promising. The inhibitors seem to be a safe option when used in a properly screened, well-matched setting that includes regular monitoring. The inhibitors appear to be effective and have the advantages of being taken orally and working fast.

Body Composition

Osteoarthritis and weight loss

Being obese has shown to be a high-risk factor for the development of osteoarthritis. This is not only from the effects of extra weight on the body’s joints but also as a result of the inflammatory effects of adipose tissue. The lower back, hips, and knees, bear the majority of the body’s weight.

An excess amount of adipose tissue on the body’s midsection and legs has been shown to negatively impact the weight-bearing joints. Promoting Lean Body Mass and encouraging weight loss lowers the risk of osteoarthritis and improves an individual’s quality of life. Exercise is regarded safe for individuals with osteoarthritis and should be incorporated to improve body composition, reduce Body Fat Mass, improve Lean Body Mass and maintain a healthy weight.

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References

Hammitzsch A, Lorenz G, Moog P. Impact of Janus Kinase Inhibition on the Treatment of Axial Spondyloarthropathies. Frontiers in Immunology 11:2488, Oct 2020; doi 10.3389/fimmu.2020.591176. www.frontiersin.org/article/10.3389/fimmu.2020.591176, accessed Jan 21, 2021.     

van der Heijde D, Baraliakos X, Gensler LS, et al. Efficacy and safety of filgotinib, a selective Janus kinase 1 inhibitor, in patients with active ankylosing spondylitis (TORTUGA): results from a randomized, placebo-controlled, phase 2 trial. Lancet. 2018 Dec 1;392(10162):2378-2387. doi: 10.1016/S0140-6736(18)32463-2. Epub 2018 Oct 22. PMID: 30360970. pubmed.ncbi.nlm.nih.gov/30360970/ accessed Jan 19, 2021.