Consumer’s Guide to Biologics for Ankylosing Spondylitis

I f you’re unhappy with your ankylosing spondylitis treatment, you may be wondering what’s next for you. That’s where biologics may come in. Biologics are a newer class of medications that have been proven to help with ankylosing spondylitis control.

The first biologic for ankylosing spondylitis was approved by the U.S. Food and Drug Administration (FDA) in 2003. Since then, more biologics have become available. These drugs have been proven to be effective at reducing inflammation that causes ankylosing spondylitis symptoms and leads to joint damage.

While biologics have been around for nearly two decades, you may have questions about how they work and whether they’re right for you. We’re here to help.

Understanding Ankylosing Spondylitis: A Type of Inflammatory Arthritis

Ankylosing spondylitis is an inflammatory form of arthritis that primarily affects your spine. In ankylosing spondylitis, your immune system, which normally protects your body from foreign substances such as bacteria, viruses, and germs, becomes overactive, creating excess inflammation in the joints of your spine. This inflammation results in pain and stiffness and may cause new bone to form, which can eventually cause your spine to fuse in a fixed position.

The exact cause of this immune response is unknown, but a gene called HLA-B27 may play a role. HLA-B27 is part of a family of genes that helps the immune system tell the difference between foreign substances and your body’s own cells.

Many people with ankylosing spondylitis have the HLA-B27 gene, but not everyone with the gene develops the condition. An environmental trigger, such as an illness or bacterial infection, may activate the immune response of ankylosing spondylitis.

How Biologics Target Ankylosing Spondylitis Inflammation

Biologics are a type of disease-modifying antirheumatic drug (DMARD), meaning that in addition to relieving symptoms of ankylosing spondylitis, they also help block the inflammatory process in your body before it even starts. Unlike traditional DMARDs, which suppress the immune system on a broad level, biologics work by targeting specific molecules that play a role in triggering inflammation.

“Biologics target specific pathways known to cause inflammation in the cartilage, bones, and joints,” says Harris H. McIlwain, MD, a board-certified rheumatologist and founder of McIlwain Medical Group in Tampa, Florida. “When inflammation starts, there may be pain, stiffness, and fatigue. Biologics may halt the process of inflammation and end pain. In doing so, they may give excellent improvement in pain, inflammation, and function.”

If you’re struggling to control your ankylosing spondylitis symptoms, don’t lose hope. There are more treatments today than ever before, and your rheumatologist can help you find a treatment — or combination of treatments — that meets your particular needs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first medication prescribed to treat ankylosing spondylitis. These drugs, which include over-the-counter and prescription options, help ease symptoms such as pain and stiffness.

If NSAIDs aren’t providing enough relief, you may be a candidate for a biologic.

Your doctor may prescribe a traditional DMARD, such as sulfasalazine, if you also have arthritis in the joints of your arms and legs. These are not typically used if ankylosing spondylitis affects your back only.

Your exact treatment plan will depend on a number of factors, including your disease severity, personal preferences, medical history, and overall health.


You’ve learned a lot about biologics. So what’s next for you?

Take some time to think about your own ankylosing spondylitis care and whether biologics are something you might want to consider. Then talk to your doctor about your options.

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