Although there’s no cure for ankylosing spondylitis yet, there are several new promising treatment options aimed at slowing disease progression and reducing pain.

New treatments are changing the lives of people with ankylosing spondylitis (AS), an inflammatory form of arthritis in the spine and large joints.

AS still doesn’t have a cure, but new medications and other therapies are getting better at managing symptoms and slowing disease progression.

A few new medications have recently come on the market and more are on the horizon. Researchers are also studying treatments beyond medication, like water and heat therapy, to see their effects on pain, stiffness, and other symptoms.

TNF inhibitors were the first new group of biologic drugs for AS. They work by blocking a protein known as tumor necrosis factor, an inflammatory chemical that induces inflammation in the body.

The Food and Drug Administration (FDA) has approved five TNF inhibitors for AS:

A doctor might prescribe one of these medications if nonsteroidal anti-inflammatory drugs (NSAIDs) haven’t managed your pain and inflammation well.

It is important to know that TNF inhibitors can increase your risk of infection because they suppress your immune system.

IL-17 inhibitors work to block an inflammatory chemical called interleukin-17. Common examples include ixekizumab (Taltz) and secukinumab (Cosentyx)

Taltz is the newest IL-17 inhibitor and has been approved since 2019.

Infections are also a side effect of this group of medications.

Bimekizumab is the first IL-17 inhibitor to target two cytokines at once: IL-17A and IL-17F and so could help people who didn’t see an improvement with TNF inhibitors.

A late-stage study called BE MOBILE 2 showed promising results with bimekizumab. Many study participants had an improvement of 40 percent or more in their AS symptoms.

In 2021, Tofacitinib (Xeljanz, Xeljanz XR) became the first in a group of drugs called Janus kinase (JAK) inhibitors approved for AS. It’s also the first new pill for AS since NSAIDs. JAK inhibitors block the signals that cause inflammation.

Xeljanz is recomended for people who have tried one or more TNF inhibitors without seeing an improvement in their symptoms. It comes as a pill that you take twice a day, or as an extended-release version that you take once daily.

In a phase 3 study of 269 participants with AS, 56 percent of people who took Xeljanz twice a day had a 20 percent or more improvement in their AS symptoms compared with 29 percent of participants who took an inactive pill (placebo). The drug started to work in as little as two weeks.

Another new JAK inhibitor, upadacitinib (Rinvoq), was approved by the FDA for approval in 2022. A 2021 phase 3 trial of Rinvoq showed that the drug slowed AS and reduced back pain and inflammation symptoms.

A new JAK inhibitor called LNK01001 is currently in phase three of its clinical trial. The study will show whether this new drug is a safe and effective treatment for AS.

Inside our gut is a miniature city full of bacteria and other tiny organisms. Scientists call this our microbiome. A growing number of studies show that problems with the microbiome might trigger and worsen AS.

According to a 2021 observational study, up to 60 percent of people with AS have inflammation in their gut, and up to 10 percent also develop inflammatory bowel disease.

Researchers looked at the effects of the TNF inhibitor adalimumab (Humira) on the microbiome of 30 people with AS. After six months of treatment, Humira helped restore the microbiome to a more healthy state in several study participants.

In participants whose microbiome changed, Humira also improved AS symptoms. Researchers said the microbiome might one day be a tool to help doctors predict who will respond to treatment and who won’t.

Medication is an important part of AS treatment. A few other non-drug therapies are also key to reducing symptoms and improving function.

Physical therapy

In this treatment, you work with a physical therapist who evaluates your needs and designs a program for you. Physical therapy can include exercise, heat, cold, electrical stimulation, and hands-on techniques.

A 2022 review of studies found that physical therapy reduces pain and improves movement and function in people with AS. Along with at-home exercises, physical therapy treatmentmay help you move more easily.

Water therapy

Exercising in water has advantages for people with arthritis. The buoyancy of the water takes stress off painful joints, while the warmth feels soothing.

Research shows that water therapy not only relieves pain but also may help slow diseases. It can be an alternative to land-based exercises if they’re too painful to do or an addition to your current exercise program. Adding aquatic exercise to other activities might also boost anti-inflammatory hormones in your body.

Swimming is a low impact activity that doesn’t wear down the joints.

Treatment options for AS are improving, with more options that help slow disease progression in addition to delaying the pain. Beyond medication, techniques like physical therapy and water therapy, are helping people with AS manage their symptoms.

If you’d like to try one of these new treatments, consider connecting with a doctor and asking about enrolling in a clinical trial.