Coping with your symptoms | Information for the public | Spondyloarthritis in over 16s: diagnosis and management | Guidance

Medicines

Early treatment of spondyloarthritis is important to relieve pain and reduce joint damage. Some medicines control the disease itself, and some help to ease symptoms. Your healthcare team will help you to find the best treatments for you.

Your healthcare team will talk with you about medicines you can try, based on your symptoms, needs, and any other medical conditions that need to be taken into account. See table 1 for different types of medicines and how they work.

Table 1 Spondyloarthritis medicines and how they work

Type of medicine	How the medicine helps
Non-steroidal anti-inflammatory drugs (NSAIDs)	Reduces inflammation and relieves pain
Biologics	Slows down your immune system's attack on your joints and spine
Disease-modifying anti-rheumatic drugs (DMARDs)	Slows down your immune system's attack on your joints
Steroid injections or tablets	Reduces inflammation

For all types of spondyloarthritis, if the medicine you try doesn't work, you should be offered a different one.

Axial spondyloarthritis

If you have axial spondyloarthritis, you should be offered a non-steroidal anti-inflammatory drugs (NSAID).

If after 2 to 4 weeks the NSAID you try doesn't give enough pain relief, you should be offered a different NSAID to try instead.

Your specialist should discuss other medicines to try if NSAIDs haven't helped or they are not right for you, for example, if they cause problems with your stomach or other medical conditions.

Other medicines for axial spondyloarthritis are biologics, which include 'anti‑TNF' medicines. In spondyloarthritis, a protein called tumour necrosis factor (TNF) is over-produced in the body. This causes inflammation and damage to bones, cartilage and tissue. Anti‑TNF medicines block the action of TNF and can reduce inflammation.

Peripheral spondyloarthritis

Depending on the extent and severity of your symptoms, your specialist may offer you a medicine called a disease-modifying anti-rheumatic drug (DMARD), steroid injections or tablets, an NSAID, or a combination of these medicines to help manage your condition.

Physiotherapy

If your symptoms are mostly in your back (axial) you should be referred to a specialist physiotherapist.

A physiotherapist is a medically trained person who can help you with your joints, muscles and movement. They should help you to create an exercise plan that can ease symptoms such as stiffness and pain. The exercise plan should include:

stretching, strengthening, and exercises to help your posture
deep breathing
exercises to move and stretch the different parts of your back and neck
aerobic exercise (exercise that makes you breathe harder than normal, for example, walking, swimming and cycling).

Your healthcare team may also discuss exercise with a physiotherapist in a warm-water pool. This is called hydrotherapy.

Help with everyday activities

If your symptoms make it hard for you to do everyday activities – such as cooking, dressing, cleaning and doing your job – you may be referred to specialist therapist. The therapist can assess your needs and help you to cope with your symptoms. For example, you might see an occupational therapist if you struggle with tasks around the house or at work, or you might see a podiatrist for help with foot problems.

If you see a therapist, they should find out about what you need, give you advice about equipment that might help, and arrange reviews to make sure that the therapy is still meeting your needs.