Advances in Therapies for Ankylosing Spondylitis

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March 19, 2023
Edward Smith

Advanced Treatments for Ankylosing Spondylitis

Ankylosing Spondylitis, or AS, is an auto-immune disease, or a disease in which the immune system malfunctions and attacks the body’s tissues, creating chronic inflammation. AS tends to attack the spine, large joints (such as the hips), and periphery joints (knees, ankles), causing pain and stiffness. Over time, the inflammation leads to joint erosion, deformities, and abnormal bone growth. When untreated, abnormal bone growth can lead to a bamboo spine, spinal stenosis, thoracic outlet syndrome, and chronic pain. This often results in loss of function and decreases the patient’s quality of life and ability to remain a productive member of society. Although there are treatments to slow the progression of AS, it remains an incurable disease.

Ankylosing Spondylitis and the Immune System

To fully appreciate how advanced treatments for AS work, it is necessary to understand what happens in the immune system to cause AS. While there are many components of the immune system, white blood cells, or lymphocytes, are the primary culprit for most AS symptoms. T cells are a type of lymphocyte whose role is to protect the body from viruses, bacteria, fungi, microorganisms, and cancer cells. There are many types of T cells within the human body, each with a specific role in the immune system. T cells recognize dangerous invaders and signal other immune cells that a threat is present. Some T cells also destroy cancerous cells or are infected with a pathogen.

Ankylosing Spondylitis damage has been associated with two kinds of T cells, known as Th1 and Th17. When these cells are activated, they protect the body, but when they are overactivated and uncontrolled, they can attack the body or signal other cells to attack. One of the ways they signal other cells to attack is through the synthesis and use of cytokines, or specific signaling proteins, called tumor necrosis factor (TNF) and interleukin 17 (IL-17). TNF and IL-17 signal cells to increase inflammation, which damages the body over time. In healthy people, the body will naturally mediate TNF and IL-17 levels. Still, in people with Ankylosing Spondylitis, Rheumatoid Arthritis, Lupus, and Ulcerative Colitis, levels remain high, furthering the cascade that causes inflammation.


The most advanced therapies for Ankylosing Spondylitis are called biologics. There are two varieties of biologics, anti-TNF drugs or TNF inhibitors and IL-17 inhibitors. These medications work within the body to block TNF and IL-17 proteins, preventing them from increasing inflammation and signaling to other cells to continue the attack. Biologics are the most effective treatment for Ankylosing Spondylitis, Rheumatoid Arthritis, Lupus, and Ulcerative Colitis. These medications include Humira, Enbrel, Cimzia, Remicade, Simponi, Taltz, and Cosentyx. Most of these medications are given via subcutaneous injection, performed by the patient at home. Remicade is provided as an intravenous infusion and must be administered by a registered nurse in an infusion center.

Side effects

Each biologic can cause slightly different side effects, which should be discussed with the patient’s physician. However, injection or infusion site reactions, such as a rash and itching, are common. Remicade is known for causing fatigue. Because they suppress a component of the immune system, all biologics risk increased infections. Upper respiratory infections are the most commonly seen in patients on biologics. Also, using biologics increases the risk of certain cancers because biologics limit cytokines that destroy tumors. Although these medications come with some possible side effects, which may sound frightening, they are the best method available to preserve the quality of life and function in what can be a debilitating disease known to create chronic pain and serious skeletal deformity.

Barriers to Treatment with Biologics

Biologics are a costly group of medications due in part to the advanced methods used to develop and produce them. TNF and IL-17 inhibitors are monoclonal antibody treatments, meaning they are laboratory-grown human antibodies created by cloning. Fortunately, a few “Biosimilars,” similar to generic drugs, are available. Inflectra and Amjevita are the most commonly prescribed biosimilars, but there are more available and more in development. While still expensive, many insurances will cover them.

Co-pays for biologics and biosimilars are often relatively high. Fortunately, most of the manufacturers of biologics have co-pay assistance programs or financial assistance programs. Because biologics are so expensive, they are often the last medication used to treat Ankylosing Spondylitis and other auto-immune diseases. Patients must constantly try and fail several different medication strategies before biologics are prescribed or authorized by insurance. For this reason, patients must learn to advocate for themselves at rheumatologist appointments, document their symptoms and be honest about pain levels and quality of life. Stoically accepting Ankylosing Spondylitis symptoms and putting off treatment is the best way to end up with irreparable joint damage. It may require persistence to be prescribed biologics, but most patients see a significant improvement once they begin treatment.

Watch the YouTube video below to learn about the top 15 treatments for Ankylosing Spondylitis.

Pre-Existing Conditions and Injuries

Anyone who has received an Ankylosing Spondylitis diagnosis has a pre-existing condition. This is particularly important when anyone with AS is injured. A pre-existing condition, like AS, means injuries can aggravate or exacerbate the condition. Typically, aggravation includes the exaggerated inflammatory response that is a hallmark of the disease. However, severe complications may arise if the injury is to the spine, including spinal cord and/or nerve impingement. AS can also make people more susceptible to specific injuries. Auto insurance companies often use that fact to avoid paying for injuries related to pre-existing conditions. Fortunately, in California, the negligent party is at fault. Immediate consultation with a skilled injury lawyer is critical to ensuring that insurance companies cover medical expenses for those with pre-existing conditions such as Ankylosing Spondylitis.

Northern California Personal Injury Attorney

I’m Ed Smith, a personal injury attorney in Sacramento. If you are suffering from an auto-immune disease due to a motor vehicle accident injury, call our experienced legal team at for free, friendly advice at (916) 921-6400 or (800) 404-5400.

See our past case history of Verdicts and Settlements.

Photo by Annie Spratt on Unsplash

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