Axial Spondyloarthritis (axSpA) Treatment Options

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are usually the first-line treatment option for managing the signs and symptoms of axSpA such as back pain and morning stiffness. NSAIDs work by blocking the production of prostaglandins, inflammatory mediators that sensitize nerve endings and cause pain. Common prescription NSAIDs used to treat Axial Spondyloarthritis include ibuprofen, naproxen, and celecoxib. For many patients, regular use of NSAIDs provides effective pain relief. However, some people do not tolerate NSAIDs well due to side effects like stomach upset, headaches, and dizziness. In such cases, other treatment options need to be considered.

Disease-modifying antirheumatic drugs (DMARDs)

When NSAIDs do not provide adequate symptom relief, DMARDs may be prescribed. Sulfasalazine is a common DMARD used to treat axSpA. It has anti-inflammatory properties and can help reduce symptoms like back pain and stiffness over time. Methotrexate is another DMARD option that may improve signs and symptoms of axSpA as well as inhibit bone loss and new bone formation. However, methotrexate use requires close monitoring by a healthcare provider due to potential side effects affecting the liver, lungs, and blood cells. For patients who do not respond sufficiently to or cannot tolerate conventional DMARDs, biologic DMARDs may be considered.

Tumor necrosis factor (TNF) inhibitors

Biologic DMARDs that specifically target tumor necrosis factor alpha (TNF-α) have revolutionized the Axial Spondyloarthritis (axSpA) Treatment. TNF is a key inflammatory cytokine implicated in the pathogenesis of spondyloarthritis. Inhibiting TNF can provide significant symptom relief and improve functional ability in axSpA patients. Common TNF inhibitors used for axSpA include etanercept, infliximab, adalimumab, certolizumab pegol, and golimumab. These medications are very effective but also expensive, with potential side effects including infections. They require administration via injection or infusion by a healthcare professional as well. Regular monitoring is needed when taking a TNF inhibitor.

Non-TNF biologics

For patients who do not adequately respond to or cannot tolerate TNF inhibitors, alternative biologic options targeting different molecules may be tried. Secukinumab is a monoclonal antibody that selectively inhibits interleukin-17A (IL-17A), another pro-inflammatory cytokine involved in axSpA. It was approved by the FDA in 2018 for treating active axSpA based on randomized controlled trials showing efficacy in reducing symptoms and inflammation. Ustekinumab, a p40 protein inhibitor blocking activity of both IL-12 and IL-23, may also benefit some axSpA patients. These non-TNF biologics offer additional treatment choices but are also quite costly. Further research on identifying biomarkers for treatment response and developing new targeted therapies is ongoing.

Complementary and alternative therapies

While medication is important for managing axSpA, complementary and alternative approaches can help support overall well-being in conjunction with standard medical treatment. Low-impact aerobic exercises like swimming and water exercises are recommended for axSpA patients as they help improve mobility and function without aggravating spine inflammation. Yoga or Pilates done regularly may aid flexibility and reduce back pain perception. Acupuncture has been shown todecrease disease activity and symptoms in some studies. Physical therapy focused on stretching, posture, and core strengthening provides additional benefits. Attention to diet, stress management techniques, heat/cold therapy, and use of orthotics or braces as needed can enhance quality of life for people living with axSpA.

Surgery for axSpA

Certain complications of longstanding, untreated axial SpA may eventually require surgery. About 10-15% of chronic axSpA patients develop bamboo spine or fusion of the spinal bones due to bony bridges between the vertebrae. This can lead to profound stiffness and debilitating pain, restricting mobility. In these advanced cases, corrective spinal fusion surgery may become necessary to alleviate symptoms. Rarely, nerve compression due to bony inflammation may necessitate nerve decompression surgery as well. Other orthopedic procedures such as hip or knee replacements may be performed in patients with severe peripheral joint damage from associated psoriatic arthritis or arthritis related to axSpA. Proper medical management aims to delay disease progression and need for surgery in axSpA for as long as possible.

Monitoring and management

Axial SpA is a chronic illness that requires lifelong Axial Spondyloarthritis (axSpA) Treatment and monitoring. Regular follow-up with a rheumatologist enables ongoing assessment of disease activity, treatment response, and potential side effects. Monitoring biomarkers like C-reactive protein and imaging for signs of inflammation aids in disease management decisions. When symptoms are controlled and inflammation remains low or absent on tests, treatment dose reduction or medication switches may be considered. However, flares are always possible, so stepping up medication as needed provides best outcomes for most axSpA patients. With proper multidisciplinary care involving medical, physical, and complementary therapies, people with axial SpA can achieve optimal spinal health and quality of life.

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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it