Treating Axial Spondyloarthritis With Injections

Medically Reviewed By William C. Lloyd III, MD, FACS
Was this helpful?
medication bottles with syringe

Inflammatory conditions affect millions of people in the United States. One of these conditions, axial spondyloarthritis, may make it difficult for you to live your life normally. This condition, which is most common in younger males, often causes symptoms related to inflammation, such as pain, stiffness, or soreness. In some cases, people experience fatigue which makes daily tasks difficult.

While this disease may be difficult to live with, there are several proven therapies that effectively manage symptoms and prevent the disease from getting worse. In most cases, treatment begins with physical therapy, range-of-motion exercise, and oral medications, like nonsteroidal anti-inflammatory drugs (NSAIDs). But if these treatments don’t work, your doctor can help you determine other therapies for managing your symptoms.

Understanding Axial Spondyloarthritis

Axial spondyloarthritis is a type of arthritis affecting the joints of the spine and pelvis. While the exact causes of the disease are unknown, doctors have linked several genes to the condition. These genes may be passed down in families; if you have a close family member with this disease, you could be more likely to develop it yourself.

Left untreated, axial spondyloarthritis may result in complications such as bone loss, spinal fusion, and spine or pelvic fractures. But you can lower your risk of these problems by talking with your doctor about your symptoms and beginning your doctor’s recommended treatment.

Treating Axial Spondyloarthritis

If NSAIDs don’t work to control your symptoms, your doctor may recommend stronger medications, including injectable medications. For many, injectables offer complete relief from symptoms without the need for daily upkeep. Injectables are often administered once a week, although some are injected only once a month.

To begin your injectable treatment, your doctor may first recommend corticosteroids. These drugs are typically injected near or directly into inflamed joints in the spine or pelvis. Corticosteroids are used to treat a variety of inflammatory conditions, since these powerful medications work by reducing inflammation. Your doctor may only recommend a short trial of injectable corticosteroids, since long-term use of these medications may cause unintended side effects like high blood pressure.

If corticosteroids don’t work, your doctor may suggest treatment with biological therapies. This newer class of drugs also works by reducing inflammation, but they may also help prevent axial spondyloarthritis from getting worse. Your doctor may recommend one of two types of biological therapies: TNF inhibitors or IL-17 inhibitors.

TNF Inhibitors

This type of biological drug targets tumor necrosis factor (TNF), a type of cytokine. Cytokines are substances secreted by certain immune system cells. While TNF levels are stable in healthy individuals, those living with axial spondyloarthritis typically have higher than normal TNF levels in their blood. Excess TNF promotes inflammation and may make symptoms worse.

TNF inhibitors are given by injection, usually once a week, biweekly, or monthly. In some cases, these medications are given by intravenous (IV) infusion at an infusion center or doctor’s office. TNF inhibitors are generally tolerated well — skin reactions at the site of injection are the most common side effect. However, these medications may increase your risk for serious infections, including tuberculosis. Staying in close contact with your doctor throughout your treatment is the best way to prevent any complications.

IL-17 Inhibitors

Interleukin-17, another type of cytokine, is crucial for defending your body against fungal and bacterial infections. Like TNF, high levels of IL-17 in the body boost inflammation and may also promote destruction of tissues like bone. IL-17 inhibitors work by blocking the actions of IL-17, reducing inflammation and preventing bone loss. Typically, patients receive one injection each week for five weeks. After this initial period, treatment moves to once every four weeks. Like TNF inhibitors, IL-17 inhibitors may increase your risk for infections like tuberculosis. Your doctor can help determine whether you’re at higher risk, and how you can stay healthy while completing treatment.

Your doctor may suggest an injectable medication together with physical activity to give you the best chance at success. Fortunately, there are several injectable treatments that may work for you. Working with your doctor is the best way to evaluate a medications’ effectiveness, which helps you stay healthy and symptom free.

Was this helpful?
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2022 Jan 7
View All Ankylosing Spondylitis Articles
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Spondyloarthritis. American College of Rheumatology.
  2. Ankylosing spondylitis. Mayo Clinic.
  3. Ankylosing Spondylitis. Johns Hopkins Arthritis Center.
  4. TNF Inhibitors. American College of Rheumatology.
  5. Injectable Corticosteroids. Johns Hopkins Medicine.
  6. Update on interleukin-17: a role in the pathogenesis of inflammatory arthritis and implication for clinical practice. Rheumatic & Musculoskeletal Diseases.