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Understanding Ankylosing Spondylitis Medications (cont.)

Disease Modifying Antirheumatic Drugs (DMARDs)

Drugs in this class that are most commonly prescribed for ankylosing spondylitis are methotrexate (Rheumatrex) and sulfasalazine (Azulfidine). These medications are generally used when NSAIDs are ineffective. Research has shown that these medications do not help significantly with spinal inflammation and work better on inflammation in the peripheral joints (such as the knees, hands and feet).

  • How DMARDs works: This group includes a wide variety of agents that work in many different ways. They all interfere in the immune processes that promote inflammation.

Methotrexate (Rheumatrex)

  • Who should not use these medications: People with the following conditions should not take methotrexate:


    • Allergy to methotrexate


    • Alcoholism


    • Liver or kidney failure


    • Immune deficiency syndromes


    • Low blood cell counts


    • Pregnant women should not take methotrexate as it is teratogenic (causes severe problems with the development of the baby).


  • Use: Methotrexate is taken orally or as an injection once per week.


  • Drug or food interactions: To lessen GI toxicity, daily administration of low-dose folic acid (1-2 mg) is recommended.


  • Side effects: To guard against problems, kidney and liver function are monitored regularly, as are blood cell counts. Methotrexate may cause headache and toxic effects to blood, kidneys, liver, lungs, and gastrointestinal and nervous systems.

Sulfasalazine (Azulfidine)

  • Who should not use these medications: People with the following conditions should not use sulfasalazine:


    • Allergy to sulfa drugs, aspirin, or aspirin-like products (NSAIDs)


    • Active peptic ulcer disease


    • Severe kidney failure


  • Use: Sulfasalazine is taken orally in varying doses with food.


  • Drug or food interactions: Sulfasalazine may decrease warfarin (Coumadin) absorption, thereby decreasing warfarin effectiveness. Sulfasalazine may increase the risk of bleeding when administered with other drugs that alter blood coagulation (for example, heparin [Hep-Lock]).


  • Side effects: Sulfasalazine may cause the following:


    • Toxicity to blood cells


    • Nausea


    • Vomiting


    • Abdominal cramping


    • Constipation

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