Promising New Treatments for Ankylosing Spondylitis

Currently, there is no cure for ankylosing spondylitis, but recent research is offering new treatment options to manage the symptoms and slow the progression of the condition.

This article will cover new guidelines for treating and testing ankylosing spondylitis. It will also include alternative treatment options available to manage the symptoms.

New Guidelines and Genetic Testing Lead to a Quicker Diagnosis

In 2019, the American College of Rheumatology developed a new set of guidelines for ankylosing spondylitis diagnosis and treatment. The goals of the new guidelines were to:

• Reduce symptoms
• Improve physical function
• Retain the ability to work or go to school
• Minimize disease complications
• Slow down skeletal bone damage

The guidelines give healthcare providers recommendations and guidance on using new medications and imaging (X-rays).

Genetic testing is one tool used in the diagnosis of ankylosing spondylitis. Genetic testing does not provide a firm confirmation or a complete diagnosis of the condition, however.

Researchers have found a variation in the HLA-B gene called HLA-B27—which plays a part in the immune system—that is linked to ankylosing spondylitis. If someone has the HLA-B27 gene, it is not guaranteed they will have ankylosing spondylitis.

The association between ankylosing spondylitis and HLA-B27 varies significantly among ethnic and racial groups. In the White population in the United States, 95% of people with ankylosing spondylitis have the HLA-B27 gene variation. Whereas 80% of people from Mediterranean countries and 50% of the African American population with ankylosing spondylitis have HLA-B27.

Other gene variations linked to ankylosing spondylitis include ERAP1, IL1A, and IL23R. These genes also play a role in the immune system. Researchers do not know how these genes affect a person's risk of developing ankylosing spondylitis.

New Medications

There are many promising, new medications for the treatment of ankylosing spondylitis. Each one has its benefits and drawbacks, which will be carefully reviewed by a healthcare provider.

JAK Inhibitors

One of the newest medications available for ankylosing spondylitis is a janus kinase (JAK) inhibitor. JAK inhibitors are used in people who do not find relief from nonsteroidal anti-inflammatory drugs (NSAIDs) and are unable to take TNFi or IL-17 inhibitors.

JAK inhibitors fall under the class of medications called disease-modifying anti-rheumatic drugs (DMARDs). One benefit of JAK inhibitors is that it is an oral pill, unlike many other medications for ankylosing spondylitis, which are infusions or injections. The two JAK inhibitors that are approved by the Food and Drug Administration (FDA) in the United States are:

• Rinvoq (upadacitinib)
• Xeljanz (tofacitinib)

JAK inhibitors work by decreasing the immune system so that the body does not attack the joints. Doing so also increases a person's risk of developing an infection. A healthcare provider will monitor blood work and test for conditions like tuberculosis before they begin a patient on a JAK inhibitor.

TNF Inhibitors

Tumor necrosis factor inhibitors (TNFi) are part of the biologics medication class. These medications block excess tumor necrosis factor (TNF), which increases inflammation in the body. Medications that are TNFi include:

• Humira (adalimumab)
• Cimzia (certolizumab pegol)
• Enbrel (etanercept)
• Simponi (golimumab)
• Remicade (infliximab)

TNFi is given through an infusion or injection. This medication is prescribed when NSAIDs are ineffective and is the first choice of biologics for ankylosing spondylitis.

TNFis can increase the likelihood of developing infections and the risk of certain cancers like lymphoma (cancer of the lymphatic system) and skin cancer.

IL-17 Inhibitors

Interleukin-17 (IL-17) is a cytokine that tells the body to start the inflammatory process. When there is too much IL-17, it can hurt the body.

IL-17 inhibitors are another medication in the biologics class. They work by stopping IL-17 cytokines from starting the inflammatory process. IL-17 inhibitors block different cytokines than TNFis, so if someone doesn't respond well to a TNFi, they may respond to IL-17 inhibitors. The two types of IL-17 inhibitors that have been approved for ankylosing spondylitis are Cosentyx (secukinumab) and Taltz (ixekizumab).

Like the other medications mentioned, IL-17 inhibitors increase the likelihood of infection. They have also been shown to increase the probability of developing inflammatory bowel disease.

IL-23 Inhibitors

Interleukin-23 (IL-23) is another cytokine that can cause inflammation in the body. The IL-23 inhibitor Stelara (ustekinumab) is a biologic medication that blocks IL-23.

This medication can also increase the chances of developing an infection, and anyone taking it will need to be monitored by their healthcare provider.

Research on Alternative Treatments

People with ankylosing spondylitis may seek alternative treatments if conventional therapies do not relieve their symptoms. Alternative treatments should always be discussed with a healthcare provider to ensure there is no contraindication (reason for a person to not receive a particular treatment or procedure because it may be harmful) to current treatments.

Water Therapy

Water therapy (hydrotherapy) is a helpful treatment in managing ankylosing spondylitis symptoms. When someone is in the water, there is less stress on the joints, which can relieve pain. Other benefits of water therapy include:

• Warm water can relax muscles.
• Being in water makes it easier to stand upright.
• Movement in water requires less effort.
• Water acts as a resistance to strengthen muscles.

A 2021 meta-analysis and systematic review found that water therapy helped ease pain and disease activity in those with ankylosing spondylitis. However, it did not change spinal mobility or functional capacity. This still makes water therapy a good alternative when land therapy is not an option.

Physical Therapy

Exercise is an integral part of ankylosing spondylitis treatment. Movement and exercise will help maintain mobility and flexibility. It is also effective at managing:

• Stiffness
• Pain
• Fatigue
• Breathing capacity

A physical therapist can help patients develop a safe and effective exercise and stretching routine to control the symptoms.

Summary

Ankylosing spondylitis is a type of spine arthritis with no known cure. There are several different treatments available to manage the symptoms of the condition. New research and medications are paving the way for better symptom control and improving quality of life.

A Word From Verywell

There are numerous medications available to people with ankylosing spondylitis. If one medication does not work, it does not mean that the whole class of medications will not be effective for you. Keep working with your healthcare provider to find the best medication regimen to manage your symptoms.