Yes. Upadacitinib (brand name Rinvoq) can reduce inflammation and improve symptoms of active ankylosing spondylitis in some adults. It is a tablet taken once a day and is usually considered when other treatments have not worked well enough or cannot be tolerated. It does not cure the condition, and because it affects the immune system, doctors check for infections and other risks before and during treatment.
How Can Upadacitinib Help Ankylosing Spondylitis?
Upadacitinib is a targeted medicine that belongs to a group called Janus kinase (JAK) inhibitors. It blocks signals inside cells that help regulate immune activity and inflammation. In ankylosing spondylitis, inflammation can affect the spine and the joints connecting the spine to the pelvis, causing persistent back pain, stiffness, and difficulty moving.
By changing these inflammatory signals, upadacitinib can help reduce disease activity. Treatment may improve back pain, morning stiffness, physical function, and the ability to carry out everyday activities. It may also help with inflammation where tendons or ligaments attach to bones. However, not everyone responds to the medicine, and symptom improvement does not mean that the disease has been cured.
What Does the Research Say About Upadacitinib?
Clinical trials have found that upadacitinib can improve symptoms of active ankylosing spondylitis. In a 14-week study published in The Lancet and available through the U.S. National Library of Medicine's PubMed research database, researchers compared upadacitinib with a placebo, a treatment without the active medicine.
By the end of the study, approximately 52% of participants receiving upadacitinib achieved a substantial improvement in their disease symptoms, compared with approximately 26% of those receiving the placebo. Researchers assessed improvements in areas including pain, physical function, and inflammation. These results support upadacitinib as a treatment option, although the response of an individual patient may differ from the results seen in a clinical trial.
Further evidence comes from studies involving adults whose ankylosing spondylitis had not responded adequately to previous biologic medicines. The European Medicines Agency's assessment of Rinvoq reports that upadacitinib improved symptoms compared with a placebo in adults whose disease remained insufficiently controlled by other treatments. This is important because some people continue to experience active disease despite trying more than one medicine.
Who May Be Prescribed Upadacitinib?
Upadacitinib is generally considered for adults with active ankylosing spondylitis when treatment with other medicines has not provided enough benefit or has not been tolerated. The exact requirements depend on the country and its approved prescribing information.
For example, the U.S. prescribing information indicates Rinvoq for adults with active ankylosing spondylitis who have had an inadequate response or intolerance to one or more tumor necrosis factor (TNF) blockers. In the European Union, the indication covers adults with active ankylosing spondylitis who have responded inadequately to conventional therapy. These differences matter when discussing eligibility and access to treatment.
The NHS guidance on ankylosing spondylitis treatment also describes JAK inhibitors as an option for people who have not responded adequately to anti-TNF medicines or cannot take them. A rheumatologist considers previous treatments, current disease activity, other medical conditions, and individual risk factors before deciding whether upadacitinib is appropriate.
What Dose Is Used for Ankylosing Spondylitis?
The recommended adult dose of upadacitinib for ankylosing spondylitis in the current U.S. prescribing information is 15 mg once daily. The medicine is taken by mouth, which means it does not require an injection or infusion. The prescribing information published by the U.S. National Library of Medicine through DailyMed provides the approved dosing instructions and precautions for Rinvoq.
The dose and suitability of treatment must be determined by the prescribing clinician. A person should not increase, reduce, or stop the medicine independently. Other medicines, existing health problems, infections, and changes in laboratory results can affect how treatment is managed.
How Long Does Upadacitinib Take to Work?
Clinical trials showed measurable differences between upadacitinib and placebo after 14 weeks. This does not mean that everyone will notice improvement at the same time. Some people may experience changes in pain or stiffness earlier, while others may need more time or may not obtain enough relief.
Follow-up appointments help the rheumatologist assess whether pain, stiffness, mobility, and daily function are improving. If the response is inadequate, the clinician may reconsider the treatment plan rather than continuing a medicine that is not providing sufficient benefit.
What Are the Risks and Side Effects of Upadacitinib?
Because upadacitinib affects the immune system, it can increase susceptibility to infections. Commonly reported problems include upper respiratory tract infections, nausea, and cough. Shingles and other infections can also occur. Some infections may become serious and require hospital treatment, so signs of a new or worsening infection should be reported promptly.
The medicine also carries important warnings about serious infections, certain cancers, major cardiovascular events such as heart attack or stroke, blood clots, and death. Some comparative evidence behind the warnings about mortality, cancer, and cardiovascular events came from studies of another JAK inhibitor in people with rheumatoid arthritis. This does not establish that the risks are identical in every person taking upadacitinib, but the warnings remain important when weighing its benefits and risks.
The U.S. National Library of Medicine's MedlinePlus information on upadacitinib explains these safety concerns and emphasizes the importance of reporting relevant medical history, including previous blood clots, heart problems, infections, and other conditions that may affect treatment decisions.
What Tests and Monitoring Are Needed?
Before starting upadacitinib, a healthcare professional generally reviews medical history, current medicines, vaccination status, and the possibility of existing infections. Screening for tuberculosis is particularly important because treatment can allow serious infections to develop or worsen. Testing for hepatitis and other checks may also be appropriate based on the person's circumstances and prescribing guidance.
Blood tests are used before and during treatment to check for changes that may affect safety. Monitoring can include blood cell counts, liver function, and cholesterol levels. The frequency of testing depends on the prescribing information, the person's results, and any other medical conditions. Vaccinations should be reviewed before treatment, and live vaccines are generally avoided during therapy.
People taking upadacitinib should tell their clinician about persistent fever, a new cough, shortness of breath, painful skin changes, or other possible signs of infection. Chest pain, sudden trouble breathing, or sudden weakness or difficulty speaking may indicate a medical emergency and require urgent assessment.
Does Upadacitinib Replace Exercise and Other Ankylosing Spondylitis Care?
No. Medication is one part of managing ankylosing spondylitis. Regular movement, exercises that support spinal mobility and posture, and a suitable physical therapy plan remain important when medically appropriate. Upadacitinib is intended to control inflammatory disease activity, not to replace these supportive measures.
The treatment plan should be reviewed over time to determine whether the medicine is improving symptoms, maintaining everyday function, and remaining safe. If its benefits are insufficient or side effects become a concern, the rheumatologist can discuss alternatives.
Is Upadacitinib the Right Choice for Everyone With Ankylosing Spondylitis?
No. Upadacitinib can be an effective option for some adults, particularly when other treatments have not worked well enough, but it is not suitable for everyone. A history of serious infections, cardiovascular disease, blood clots, cancer, or certain other health problems can influence the decision. Age, smoking history, other medicines, and pregnancy-related considerations may also matter.
The decision involves comparing the potential improvement in pain, stiffness, and function with the risks of treatment and the availability of alternatives. A rheumatologist can explain whether upadacitinib fits the individual's medical history and treatment goals. The aim is to find a safe, sustainable approach that controls inflammation and supports daily life.