The first drugs developed to combat arthritic conditions are called DMARDs or Disease Modifying Anti-Rheumatic Drugs.  These drugs are chemotherapy drugs given in small doses daily.  They include:


    Hydroxychloroquine [high-drox-ee-kloro-qu-in] 

    Sulfasalzine [sulf-a-sal-zeen]

    Methotrexate [meth-o-trex-ate]


There are many challenges with these drugs.  First it will take 3 to 6 months of continuous use, if you can tolerate them, before you will feel any potential benefit from taking them.  Think on that for just a moment…you potentially will have struggle through 9-18 months of “trying” to MAYBE get a benefit. 




Hydroxychloroquine was originally developed to treat malaria.  By accident when giving the drug to malaria patients with arthritis they discovered the drug causing improvements in the arthritis as well.  Doctors still today have no idea why or how hydroxycholoroquine works to improve arthritis.  


I tried hydroxchloroquine first and it was awful.  I only took the drug for a week before discontinuing it bc of the side effects.  The major side effect for me were intense headaches.  Within two days the headache quickly turned into a debilitating migraine.  I couldn’t get out of bed and had to have pillows on top of my head to block out all light and sounds.  


It is actually no longer recommended for the treatment of AS…what a difference 5 years make!




Next was Sulfasalzine.  It is a combination of aspirin and a sulfa antibiotic.  It was discovered about 70 years ago and again doctors also do not know how it actually works to stop arthritis. It does treat swelling, pain and stiffness fairly well in patients with Rhuematoid Arthritis.  


These pills are HUGE 500 milligrams each and you have to take a lot of them.  The protocol for sulfasalzine is to start week one taking 2 pills a day, week 2 you take 4 pills a day and week 3 you take 6 pills a day for a total of 3 GRAMS which is a massive dose.  


The side effects of this medication are stomach pain, nausea and diarrhea.  Which makes complete sense bc it is a large dose of aspirin which causes stomach ulcers and antibiotics which kills bacteria in your gut causing diarrhea.  When your stomach hurts and you have diarrhea you get nausea pretty easily.  


Bc of the quantity of aspirin it can also damage your liver so you have to have blood tests to check your liver functions monthly.   The other thing it does is cause mouth sores, headaches and skin rashes. 


To try to head off the side effect you have to take more drugs.  These include Nexium to help protect the stomach from ulcers and an anti-nausea medication called promethazine.  Nexium reduces bone calcium so you have to get yearly bone density tests and promethazine causes extreme drowsiness…think of travel sickness meds and benadryl only much worse.   


My experience with Sulfasalazine was short, only a month before the side effects were just not worth and potential benefit.  The anti-nausea meds made me very very sleepy and the stomach pain was awful.  




So next up was Methotrexate.  Methotrexate is a chemotherapy drug that was developed to fight cancer. It is given to AS patients in much smaller doses orally.  Again doctors don’t know why it works against AS but it does in some cases and usually is given in combination with other drugs. 


It is a very dangerous drug.  It can cause liver damage, bone marrow toxicity, and lung problems.  It also weakens your immune system and you get every cold that comes your way.  It requires monthly blood tests to check your liver as well as your red blood cell count.  


I tolerated the medication however I did start to lose my hair, developed mouth ulcers and my finger nails became extremely brittle.  It also created dry mouth and my gums would bleed all the time.  This lead to cavities in a short amount of time, 1month.  I didn’t really feel much of a benefit but I also only took the medication for two months.


After two months of side effects I decided to really research the drug to find out what it was really doing to my body.  This is when I found out that methotrexate is also used as an abortion drug and causes fatal fetal abnormalities.  You cannot try to become pregnant on this medication nor can you become pregnant for over a year or year and a half after stopping the medication.  I immediately stopped taking the medicine bc it goes completely against my religious beliefs.  I was EXTREMELY upset with my doctor for not telling me and fired him for not disclosing this information.  


Now the other side of treating AS is getting the insurance companies to approve your medication.  Biologics have been proven to be much more effective with less harmful side effects in controlling AS but they are EXTREMELY expensive medications.  Therefore in order to be eligible to get biologic therapy approved the insurance companies require you to try and “fail” hydroxychloroquine, sulfasalizine and methrotrexate first for 6 months.  I failed them all within 4 months and then had to wait for month 6 to come to be approved to try my first biologic.