How Long Does It Take for Medications to Relieve Ankylosing Spondylitis Pain?

Q: How Long Does It Take for Medications to Relieve Ankylosing Spondylitis Pain?

Hello, thank you for your question. <br>Here are my responses： <br>1) For patients with ankylosing spondylitis experiencing sacroiliac joint pain, if they find relief with Celebrex (celecoxib), it typically takes a few days (usually less than a week) to notice an effect. <br>We u

How long does it take for medication to be effective in treating ankylosing spondylitis?

Hello Doctor:
1) For patients with ankylosing spondylitis experiencing sacroiliac joint pain, if they find relief with Celebrex (celecoxib), how long should they take it to achieve complete pain relief? Similarly, if they find relief with Salazopyrin (sulfasalazine), how long should they take it for complete pain relief? It seems that Celebrex does not provide immediate relief for the buttock pain associated with ankylosing spondylitis, unlike how Tylenol (acetaminophen) works for headaches.
2) Over the past 8 months of taking Celebrex, I have been recording my daily medication dosage, pain levels, and inflammatory markers.
I have observed that during the first half month or month of testing, when I averaged 2 or 1.5 pills daily, my ESR (erythrocyte sedimentation rate) was higher.
Conversely, when I averaged 1 or 0.5 pills daily, my ESR seemed to normalize more easily.
Is it possible that for some patients, a higher dosage of Celebrex could lead to an increased ESR? Thank you, Doctor.

Jie, 20~29 year old female. Ask Date: 2022/05/24

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1) For patients with ankylosing spondylitis experiencing sacroiliac joint pain, if they find relief with Celebrex (celecoxib), it typically takes a few days (usually less than a week) to notice an effect.
We usually monitor the response for a month, and if the effect is inadequate, we may switch to another medication or investigate other potential causes aside from ankylosing spondylitis.
If the patient is taking Salofalk (mesalamine) and finds it effective, the timeline for relief would be similar.
2) Over the past eight months of taking Celebrex, I have been recording my daily medication intake, pain levels, and inflammatory markers.
I have observed that during the first half of the month or month, when I averaged taking 2 or 1.5 pills daily, my ESR (erythrocyte sedimentation rate) was higher.
Conversely, when I averaged taking 1 or 0.5 pills daily, my ESR seemed to normalize more easily.
Is it possible that some patients experience a higher ESR with increased doses of Celebrex?
This is unlikely.
Celebrex has minimal impact on inflammatory markers.
Any fluctuations in ESR should be investigated separately and are not related to the use of Celebrex.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/05/24

More Info

Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, leading to pain and stiffness. The management of pain associated with AS often involves the use of medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs) like sulfasalazine (Salsal) and biologics like secukinumab (Cosentyx) or adalimumab (Humira).
1. Timeframe for Pain Relief: The time it takes for medications to relieve pain in patients with AS can vary significantly based on the individual, the severity of the disease, and the specific medication used. For NSAIDs, patients may begin to experience relief within a few days to a week of starting treatment. However, achieving complete pain relief may take longer, and some patients may not experience total relief even with optimal dosing.
For medications like sulfasalazine, it typically takes several weeks to a few months to see significant improvements in symptoms. Clinical studies suggest that it may take up to 12 weeks for patients to notice substantial benefits. This delay is due to the mechanism of action of sulfasalazine, which works by modulating the immune response rather than providing immediate pain relief like NSAIDs.
In your case, if you are finding that sulfasalazine is not providing the immediate relief you desire, it is important to remember that it is not designed to act as a fast-acting pain reliever like acetaminophen or ibuprofen. Instead, it is more about long-term management of the disease.

2. Impact of Dosage on ESR: Your observation regarding the relationship between the dosage of sulfasalazine and your ESR (erythrocyte sedimentation rate) levels is intriguing. ESR is a common marker of inflammation in the body, and it can be influenced by various factors, including the underlying disease activity, the presence of other inflammatory conditions, and even the medications being used.
It is not uncommon for some patients to experience fluctuations in their inflammatory markers based on medication dosage. In some cases, higher doses of certain medications may lead to increased inflammation due to various reasons, including potential side effects or interactions with other medications. However, this is not universally applicable, and each patient's response can be quite different.
It is essential to maintain open communication with your healthcare provider regarding your observations. They can help interpret your results in the context of your overall treatment plan and may adjust your medication regimen based on your response.
In conclusion, managing ankylosing spondylitis requires a comprehensive approach that includes medication, physical therapy, and lifestyle modifications. While medications like sulfasalazine can take time to show their full effect, they play a crucial role in controlling the disease over the long term. If you have concerns about your medication or its effects on your inflammation markers, discussing these with your rheumatologist will provide you with the best guidance tailored to your specific situation.

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