Biologic Drugs and AS

Hi Peter.  Great post, and interesting question.   I bet most poelpe struggle with a diagnosis that has no cure.  The drugs assist with symptoms and modify the disease but the root cause is not uncovered.  

I would like to follow this discussion.  

I have often questioned my diagnosis of SpA (SA).  Ofcourse technology (MRI) etc has made early diagnosis possible and it is benefecial to start medications asap BUT with consideration of risk versus beneefit.  

I am currently on sulfasadine.  I will give it 12 weeks.  I hope it works as in my view I would like to avoid some of the more compliated and stronger drugs but a the same time I am greatful that there may be something to help me in the (near) future when/if I need it.  

I have also heard professionals say the same thing .."if it doesnt work (the drug) then at least we know its not that (the disease)".  

All the best.

 

I forgot to mention, get a second opinion too.

Hi these drugs suppress the immune reaction which drives acute active arthritis in new joints it will have little or no effect on degenerated discs or osteoarthritis from worn out joints. They should work on active illness with fever, flu like symptoms and hot joints.

Thanks guys.  A couple of random thoughts here.  First there was one time when the antiinflammatory prednisone was given to me intravenously when I was having a fusion surgery on my neck.  The effect of that drug was dramatic and lasted for a while thereafter.  That is the only drug (standard antiinflammatory or biologic) which had any noticeable and undeniable effect.  Oral prednisone which I have taken for "flares" did not have the same dramatic effect.   I have been told that what was given to me in surgery was not technically prednisone even though it was called prednisone but regardless it had a solid effect.  I joked with the surgeon that he was so good that he fixed two problems at the same time. But clearly I do have structural issues going on too.  I've had three spinal surgeries and have been told that the degenerative disc disease is bad enough in the lumbar that I may be looking at a fusion of that whole area somewhere down the line.  And I have had numerous facet rhizotomy procedures to deal with pain coming from the facet joints.  That is the difficult part of diagnosing this monster when you have other suspects that could very well be causing pain.

As to the second opinion Kay I have seen four rheumatologists now.  The first made the original diagnosis.  Subsequent rheumys agree that she was "probably right" but they were less enthusiastic.  But that goes back too to a previous discussion I've had on this forum that there are too many rheumatologists out there that are not particularly skilled or experienced with the family of AS illnesses.  They were stuck on the fact that I did not show radiologic evidence of ankylosing and did not consider a non-radiographic spondyloarthropathy.

But getting back to the main point of this thread brings up a related question in my mind.  If AS in its various forms is an autoimmune process which causes inflammatory reactions in the spine and elsewhere isn't it true that the inflammatory reaction causes physical degeneration?  It would seem that as time goes on you are getting more and more physical degeneration in the spine which causes more and more pain outside of the direct pain of the autoimmune reaction.  So, over time, if the drug works to counteract the autoimmune response it will have less and less actual impact on the pain aspect because the pain is coming from degenerated spinal structures that arent coming back.  Maybe I'm overthinking this thing.

Hi Kay

  By radiographic I mean x-ray or MRI evidence of fusing and/or evidence of inflammation that shows up in the SI joints.  My imaging studies show a great deal of degeneration but do not show the classic AS fusion process going on.  Also, even though I have considerable pain which is suspected to come from the SI joints, imaging studies of those areas do not show the corrosive effects of chronic inflammation.  Hope this clarifies a bit.

My diagnosis was made on a few other things:

1) I am HLA-B27 positive.

2) I have a long history (many years now) of back pain which is absolutely worst in the morning and gets somewhat better with subsequent movement and time

3) Family history of the same issue.  Mother started this circus with similar problems and all three of her offspring are similarly afflicted.

I also have some anecdotal evidence which speaks to me even though it wouldnt speak to a medical person.  As a child I remember hearing my mother once say that the doctors actually told her that her back was fusing.  She used those words but at the time I had no reason to take that literally.  She was also German and often her words were filtered through her German/English language and you sometimes didnt know when to take her words literally.  But also my brother is the worst off physically of the offspring.  His spine is now very deformed and he has the classic look of some AS patients.  He suffers from severe kyphosis of the neck and his chin essentially rests on his chest.  His spinal deformities which came later in life have now left him a paraplegic wit no control of his legs.  My sister needs a walker to get around because she is also having nerve issues because of the spinal problems.  But alas none of my offspring nor my mother ever pursued this issue by seeing a rheumatologist so I cannot get any corroboration from that.