by Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are usually the first line of treatment for axSpA as they are effective in reducing inflammation and pain. Common Axial Spondyloarthritis prescribed include ibuprofen, naproxen, and celecoxib. While NSAIDs provide effective short-term relief, they only treat symptoms and do not stop disease progression. Patients may require higher and more frequent doses over time as tolerance to the medication increases. Long-term NSAID use can increase the risk of side effects like gastrointestinal bleeding, kidney problems, and cardiovascular issues.
Disease-Modifying Antirheumatic Drugs (DMARDs)
For patients with active disease despite NSAID treatment, DMARDs may be recommended. The only DMARD currently approved by the FDA for treating axSpA is sulfasalazine. It works by reducing inflammation and slowing structural damage. Sulfasalazine is generally well-tolerated but can cause side effects like nausea, vomiting, headache and rash. It is not very effective in treating extra-articular manifestations like uveitis, psoriasis or inflammatory bowel disease. Other DMARDs sometimes used off-label include methotrexate, hydroxychloroquine and leflunomide but strong evidence supporting their long-term effectiveness is still lacking.
Biologic DMARDs
When NSAIDs and conventional DMARDs do not provide adequate relief or control of symptoms, biologic DMARDs may be prescribed. These are injectable or infusable medications that target specific proteins involved in the immune system overreaction seen in axSpA. The three main biologics used are tumor necrosis factor (TNF) inhibitors – etanercept, infliximab and adalimumab. Extensive research has shown their superiority over NSAIDs and other drugs in reducing symptoms, inflammation and protecting joints from structural damage progression over the long run. Common adverse effects include respiratory infections, headaches and injection site reactions. Rare but serious risks include allergic reactions and increased chances of some infections or cancers with long-term usage. Due to these safety concerns, biologics are generally reserved for persistent high disease activity.
Steroids
Oral or injected corticosteroids provide potent short-term anti-inflammatory effects. They may be used sparingly during acute disease flares to quickly reduce swelling and pain when other Axial Spondyloarthritis (axSpA) Treatment are not controlling the symptoms adequately. However, steroids are not suitable for long-term daily management as they carry significant side effect risks like weight gain, high blood pressure, weakening of bones, worsening of diabetes and psychiatric issues if taken continuously over months to years.
Back Exercises and Physical Therapy
Strengthening and stretching exercises target specific areas and movements that are affected by axSpA like the back, hips, shoulders and chest. A physiotherapist can design a customized home program that includes yoga, Pilates, swimming etc. to improve mobility, posture, muscle tone and reduce tender spots. Heat/ice therapy, acupuncture, and transcutaneous electrical nerve stimulation (TENS) may also help relieve pain and stiffness. Maintaining an active lifestyle is important for overall wellness.
Surgery
Joint fusion surgery may be recommended in severe, progressive axSpA cases that do not respond to medical therapies. The goal is to decrease pain from inflamed facet joints in the spine by fusing them together into a single rigid bone to prevent any movement. This provides stability but eliminates flexibility at that spinal segment. Alternative options like artificial discs are still under investigation. Surgery to correct inflammatory eye conditions like recurrent uveitis may sometimes be needed.
Complementary Axial Spondyloarthritis (axSpA) Treatment
While strong evidence is still lacking, some complementary therapies anecdotally reported as providing relief for axSpA include fish oil, turmeric, boswellia, ginger, CBD oil, probiotics, mind-body practices like yoga, acupuncture, massage and hypnotherapy. More research is underway to better understand their effectiveness and safety either alone or when combined with conventional treatments. Managing stress, diet, adequate sleep and social support also play a role in disease management.
Promising New Drugs
Several new classes of biologic DMARDs targeting different parts of the immune pathway are in development stages. These include drugs blocking interleukin 17, 23, 1 alpha. Secukinumab was the first IL-17 inhibitor approved in 2018 as a treatment option after TNF blockers. Subcutaneous and oral JAK inhibitors show early promise based on preliminary data. Also in the pipeline are B cell therapies like belimumab, SIK2/3 inhibitors and GPR35 receptor agonists. Efforts are also on to develop gene and cell therapies. These newer options could expand treatment options in future if proven effective and safe through rigorous clinical trials.
In conclusion, significant progress has been made over the past two decades in managing the symptoms and slowing progression of axial spondyloarthritis through a combination of pharmacological therapies, rehabilitation measures and surgery when needed. Though there is no cure yet, earlier diagnosis and treatment as per current guidelines is key to achieve optimal outcomes for patients. Continuous efforts are being made to better understand disease mechanisms, develop biomarkers for improved diagnostics and evaluation of treatment response. More research in further elucidating the immune pathways involved promises to uncover novel drug targets that could also potentially cure or even prevent this chronic disease in the future.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
Ravina Pandya, a content writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemicals and materials, etc. With an MBA in E-commerce, she has expertise in SEO-optimized content that resonates with industry professionals.
