强直性脊柱炎

强直性脊柱炎Medications

Your complete guide to treating your AS with medication, from the tried-and-true to the latest and greatest.

byShelby Deering 卫生作家

January 20, 2023

GettyImages/andreswd

January 20, 2023

If you’ve justbeen diagnosed with强直性脊柱炎（AS）, there’s probably one question above all others in your mind: What can I do about it? Quite a bit, as it turns out. In addition to a safe,AS-specific exercise program, yourankylosing spondylitis treatmentsmay involve one or more作为药物。

药物可能有助于减轻和管理AS的症状，因此它们可能会在您的治疗计划中占有一席之地。根据期刊研究臀部和骨盆，这些药物的强直性脊柱炎的急剧进展为患者提供了可行的手术替代方法。

Today’s medication options include: Non-steroidal anti-inflammatory Drugs (NSAIDs); disease-modifying antirheumatic drugs (DMARDs); biologics (a subset of DMARDs); and corticosteroids.

Though medicine cannot cure your AS, it may reduce your pain and enable you to more fully participate in the activities you enjoy. Let’s take a closer look at the drugs you may be prescribed to manage your ankylosing spondylitis-related back and joint pain.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs reduce pain and inflammation, and are the most common type of drug therapy for AS. In fact, they make up approximately5% to 10%of all medications prescribed each year. This class of medication is often part of the first line of treatment for AS.

• 例子：布洛芬，吡格敏和萘普生

• Over the counter or prescription:Most NSAIDs are available over the counter, but some (e.g., COX-2 inhibitors) require a prescription.

• Key considerations:You may need to takeNSAIDsfor a few weeks before you notice any measurable improvement. Also, you will need to be monitored by your doctor when you use NSAIDs for long periods.

NSAID副作用

Long-term use of NSAIDs havepotentially serious side effects, including gastrointestinal tract bleeding, kidney disease, and high blood pressure. They can also put you at increased risk of congestive heart failure and heart attack,根据Cureus发表的研究and elsewhere.

“ NSAID是世界上最常用的药物类别之一，”Saad B. Chaudhary, M.D.，位于纽约市西奈山医学中心的骨科脊柱外科医生。“严重的副作用并不常见。但是，年龄较大，多种医疗问题，药物剂量增加以及与其他药物的相互作用会导致严重的副作用。据估计，医院入院的5％至7％与药物的不良影响有关，其中11％至12％的毒品事件可能是由于NSAID use。”

Minor side effects that can result from NSAID use include indigestion, heartburn, abdominal pain, diarrhea, headaches, drowsiness, dizziness, electrolyte abnormalities, and tinnitus or ringing in the ears.

NSAIDs form a cornerstone ofankylosing spondylitis treatment, but in more advanced disease, they may not be strong enough to manage symptoms. If that’s you, not to worry: There are a number of powerful alternatives.

Conventional Disease-Modifying Antirheumatic Drugs (DMARDs)

DMARDs control inflammation by tamping down your body’s inflammatory response, and may help stop or slow the progression of AS, although theyhave been foundto more effectively keep symptoms at bay rather than modify the disease.

• 例子：Sulfasalazine, hydroxychloroquine, and methotrexate

• Over the counter or prescription:Prescription only

• Key considerations:Researchers are still trying to understand the extent of DMARDs’ ability to stop or slow AS disease progression. DMARDs are not quick fixes—they work slowly, they all work differently, and they must be taken exactly as your doctor instructs.

Biologics (TNF-blocking Agents)

Biologics for ankylosing spondylitis are a newer generation of DMARDs and may be used if traditional DMARDs don’t reduce symptoms of AS. Unlike traditional drugs, biologics are not synthesized in a lab, but are bioengineered from living cells. These genetically engineered drugs block the pathway of tumor necrosis factor-alpha (TNF-α) protein and other specific inflammatory proteins to reduce inflammation.

These medications have been found to be generally safe and effective, but adherence to treatment is mixed:One study in关节炎研究和治疗发现五年后，只有63％的人仍接受生物学治疗。

“生物制剂有助于缓解症状和疾病进展缓慢。它们通常被添加到其他治疗中。”Patrick Doherty, M.D.，位于康涅狄格州纽黑文市的耶鲁医学的神经外科医生和脊柱外科医生。它们与常规dmard不同，因为Doherty博士说，因为生物制剂往往“通常更适合疾病”，这更可能改变疾病进展。

• 例子：Adalimumab, certolizumab, etanercept, golimumab, ixekizumab, infliximab

• Over the counter or prescription:Prescription only

• Key considerations:您可能会通过静脉输注（IV）或注射获得生物学。如果您不对一种生物学做出反应，那并不意味着您不会对其他配方做出反应，因此您的医生可能会开出另一种生物学。症状应在开始生物药物治疗的几周内改善。

TNF Blockers

TNF blockers, otherwise known as tumor necrosis factor inhibitors (TNFi), are a class of drugs that help stop inflammation and suppress the immune system by blocking the activity of TNF, an inflammatory molecule.

• 例子：Rituxan (rituximab), Kineret (anakinra), Actemra (tocilizumab), Humira (adalimumab), Enbrel (etanercept)

• Over the counter or prescription:Prescription only

• Key considerations:Chaudhary博士说：“这些药物的使用是为那些未通过两种不同的NSAID治疗作为初始疗法的人保留的。”“这些药物也用于具有重大疾病负担的患者。”

其他生物制剂

There are other biologics that your doctor may consider for your AS treatment plan, especially if you haven’t responded well to TNF inhibitors. They include:

• Interleukin blockers, which are “typically used to treat psoriatic arthritis and moderate to severe plaque psoriasis,” as Dr. Doherty says.

• Doherty博士解释说，“当疾病不受甲氨蝶呤或TNF阻滞剂控制时，用于治疗中度至重度RA，” Doherty博士解释说。

• B-cell blockers, a type of medication that, as Dr. Doherty says, are “typically reserved for patients with an unsatisfactory response with methotrexate or TNF blocker.”

生物副作用

与任何药物一样，在开始生物学之前，有一些副作用要考虑。他们包括：

• Immunosuppression, which can expose patients to more infections such as upper respiratory infections or UTIs

• Inflammatory bowel disease

• Infection. “Rarely, more serious infections such as tuberculosis or fungal infections might develop,” says rheumatologistTarek Kteleh，医学博士，印第安纳州中部风湿病学的创始人。

有针对性的合成DMARD

Targeted synthetic DMARDs (tsDMARDs or small molecules) such asJanus kinase inhibitors (JAKi)将生物制剂的精度与常规DMARD的便宜和密集制造过程相结合。Doherty博士说，它们偶尔被用于AS，并表现出功效和受益，但是更多数据is needed. They can be combined with methotrexate or other conventional DMARDs.

• 例子：Rinvoq (upadacitinib), Xeljanz (tofacitinib)

• Over the counter or prescription:Prescription only

• Key considerations:The FDA添加了一个黑匣子警告- 最严重的是，在一项安全研究之后，这两种JAK抑制剂都显示，与50岁以上的TNF抑制剂相比，Tofacitinib的血凝块和死亡的风险更高，至少有一种合并症。告诉您的医生您当前或过去的吸烟习惯，或者过去曾经心脏病发作或中风。

皮质类固醇

如果您要服用的NSAID不能减轻您的炎症，您的医生可能会开出皮质类固醇。

• 例子：Methylprednisolone and cortisone

• Over the counter or prescription:Prescription only

• Key considerations:皮质类固醇for AS may be taken by mouth or as injections for ankylosing spondylitis into your joints (such as a sacroiliac joint or hip joint—but not joints in your spine). These medications are typically used on a short-term basis to provide quick, temporary relief during flare ups.

药物技巧

With many medications available to help you manage your强直性脊柱炎症状, your doctor will work with you to develop the appropriate regimen.

Make sure you talk to your doctor about all medicines you take—even over-the-counter drugs, vitamins, herbal products, and supplements—so he or she can create a plan that safely and effectively addresses your AS symptoms and pain. Once you’ve been prescribed medication, take it exactly as prescribed (even when/if you’re feeling well). Also, talk to your doctor if symptoms aren’t going away or new ones have emerged.

药物以及健康的生活方式和强直性脊柱炎运动，是缓解症状并减轻其对日常生活的影响的强大工具。

认识我们的作家

Shelby Deering

Shelby Deering is a lifestyle writer from Madison, Wisconsin specializing in wellness, mental health, and home design. She’s written for national publications and websites including Good Housekeeping, Healthline, Talkspace更多的

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