Ankylosing Spondylitis: Treatment Options and Patient Concerns - Internal Medicine

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Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. As a patient diagnosed with AS for 2.5 years at the age of 18.8, you have raised several important questions regarding treatment options, monitoring, and the implications of using biologic agents. Let’s address your concerns systematically.

1. Efficacy of Biologics vs. NSAIDs: Biologic agents, such as TNF inhibitors (e.g., Infliximab, Etanercept) and IL-17 inhibitors (e.g., Secukinumab), have been shown to be effective in managing AS symptoms and can lead to significant improvements in disease activity. The likelihood of achieving remission or significant symptom relief may be higher with biologics compared to traditional NSAIDs, especially for patients who do not respond adequately to NSAIDs. However, the decision to switch to biologics should be made in consultation with your rheumatologist, considering your specific disease characteristics and treatment history.

2. Cardiovascular Monitoring: While routine blood tests for liver and kidney function are essential when on NSAIDs and biologics, cardiovascular health is also crucial, especially since AS is associated with an increased risk of cardiovascular disease. You may consider monitoring lipid profiles, blood pressure, and possibly inflammatory markers like hs-CRP (high-sensitivity C-reactive protein) to assess cardiovascular risk. Discussing these tests with your healthcare provider is advisable.

3. Impact of Physical Activity on Inflammatory Markers: Engaging in vigorous activities, such as playing badminton, can indeed lead to temporary increases in inflammatory markers like CRP and ESR (Erythrocyte Sedimentation Rate). If you experience pain in your hips after such activities, it is reasonable to expect that your CRP and ESR levels may rise as a response to inflammation. It’s essential to communicate any changes in symptoms or activity levels to your healthcare provider, as this can inform your treatment plan.

4. Reapplying for Biologics After Discontinuation: If you stop biologic treatment and subsequently experience a resurgence of symptoms and elevated inflammatory markers, you may need to go through the application process again for public funding. This typically involves demonstrating that you have tried at least two NSAIDs without sufficient relief and meeting the criteria for disease activity (BASDAI, ESR, CRP). The requirement for documentation of previous treatments and disease activity is standard to ensure that biologics are used appropriately.

5. Use of Biologics in Young Adults: Regarding your concern about the safety and efficacy of medications like Humira (Adalimumab) in young adults, while the prescribing information may indicate limited data for children, many rheumatologists prescribe these medications to young adults based on clinical judgment and available evidence. At 18.8 years, you are considered an adult in terms of treatment decisions. If your disease progresses and NSAIDs are no longer effective, discussing the potential use of biologics with your rheumatologist is warranted. They will consider your overall health, disease severity, and any potential risks associated with treatment.

In conclusion, managing AS requires a comprehensive approach that includes medication, lifestyle modifications, and regular monitoring. It’s crucial to maintain open communication with your healthcare team to tailor your treatment plan to your evolving needs. If you have further questions or concerns, do not hesitate to reach out to your rheumatologist for personalized advice.