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2. Myths and Facts About Back Pain

Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Although medications do not cure ankylosing spondylitis, they do relieve pain and stiffness, allowing the person to exercise, to maintain correct posture, and to continue daily activities. The medications used in the treatment of ankylosing spondylitis include the following:

• Nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly used medications. NSAIDs do not cure ankylosing spondylitis, but they reduce the pain and stiffness of ankylosing spondylitis. Commonly used NSAIDs include diclofenac (Cataflam, Voltaren), ibuprofen (Advil, Motrin), ketoprofen (Orudis), naproxen (Aleve, Naprosyn), piroxicam (Feldene), etodolac (Lodine), indomethacin, oxaprozin (Daypro), nabumetone (Relafen), and meloxicam (Mobic). People with ankylosing spondylitis respond differently to each of the many NSAIDs available. It is well known that an NSAID that works for one person may not work for another person. Be patient and actively participate in deciding which NSAID provides maximum relief. Side effects of NSAIDs include heartburn, nausea, abdominal pain, diarrhea, and bleeding ulcers. To decrease the risk of stomach upset, NSAIDs should be taken with food. Sometimes, taking antacids or other medicines may be necessary to prevent heartburn and ulceration caused by NSAIDs.



• Sulfasalazine (Azulfidine) has been shown to reduce the pain and stiffness of ankylosing spondylitis, especially of peripheral joints (such as the hips and shoulders). Potential side effects include rash, nausea, and diarrhea. A rare but serious side effect is a severe reduction in the number of white blood cells, which predisposes the individual to life-threatening infections. Blood counts can be monitored with blood testing.



• Newer medications, called biologics, work by altering critical messengers of inflammation. Biologics that block tumor necrosis factor (TNF)-alpha (a substance that plays a role in the inflammatory process of ankylosing spondylitis) can be extremely effective in treating ankylosing spondylitis. Examples of TNF-alpha blockers include etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade). Etanercept and adalimumab are administered as injections. Infliximab is administered as an intravenous infusion.



• Other medications such as methotrexate (Rheumatrex), azathioprine (Imuran), cyclophosphamide (Cytoxan), and cyclosporine (Sandimmune, Neoral) may be helpful in the treatment of ankylosing spondylitis, especially when peripheral joints are involved. They are prescribed only if NSAIDs are not effective in controlling the symptoms of ankylosing spondylitis. Each has specific potential toxic side effects that require monitoring, including regular blood testing.



• Oral corticosteroids, cortisone medications such as prednisone, are occasionally helpful in controlling symptoms. However, they are generally used for only short-term management.

For more information, see Understanding Ankylosing Spondylitis Medications.

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