Hi Paul,... these are some excellent questions you're asking.

Quote:

Is there any research that shows early intervention with biologics to be advantageous? Do less advanced cases of A.S. actually do better on biologics (or even go into remission)?



I think the answer to this is - yes.

TNF antagonists have excited the Rheumatology community because they actually work! Basically, the traditional treatments for AS (nsaids, dmards and exercise) are useful in providing symptomatic relief but do not help to modify the course of disease progression. The leading Rheumatologists view TNF antagonists as having a very good safety profile and far superior efficacy than conventional treatments, especially for AS (and the SpAs) which is the main reason they are being prescribed. Ank Spond is a chronic, progressive disease.

From what I've read, employing the biologics early on appears to be the most beneficial in achieving more dramatic results (including higher rates of remission) in comparison to those of us with long standing disease, yet TNF antagonists are not a cure by any means, so when the drugs are stopped the disease rebounds.

Despite their efficacy, anti-TNF meds are not and probably shouldn't be prescribed for all AS patients. There will be philosophical differences between doctors in deciding when biologics should be prescribed (despite ASAS/EULAR recommendations for guidance) but there are also barriers to access, mostly funding issues, that prevent these meds from being used as first-line treatments for folks whose symptoms are not sufficiently controlled with nsaids.

Patients may view biologics as a last resort but I really doubt most Rheumatologists view it that way any more. Now I think they are looking at each patients disease activity, how rapid are signs of progression, how receptive the patient is, how involved (iritis, IBD etc?), how well managed? What is the likely outcome? In the meantime, they are madly trying to learn the genetics behind why they work better for some than others, so they can target these therapies more directly.

If I had a mild case I doubt I would be on Remicade and I wouldn't want to be. Mind you, if I had a mild case I wouldn't want to be on nsaids or mtx and the like, either. I think it is great that you have access and are considering your options thoughtfully. You can always re-assess where you are and keep these weapons for if things change. AS can be a sneaky beast and hard to predict but you know yourself better than anyone! Next time you visit your Rheumy, you may want to ask what they feel your prognosis is and why.

Running and skiing and sleeping are good!
Cheers,
mig