Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Enbrel vs. DMARDS

I'd like to ask you guys for some suggestion. Under what conditions did some of you start using Enbrel? When the DMARDS failed to work, or went ahead to use Enbrel anyway even if the DMARDS worked to some extent just because Enbrel could stop the damage process?

I am facing a problem between continuing on DMARDS and start using Enbrel. I have been on and off Sulfasalazine for my right knee inflammation. I stopped taking medication for about 50 days and now my right knee feels painful again so I resumed taking Salfasalazine. But since Salfasalazine is known to work very slowly, I feel like I probably should use Enbrel to stop the damaging process immediately first. In the past, while using Vioxx and Salfasalzine sometimes I felt relatively fine but overall the swelling was never gone and my walking is still not normal as before. My rheumy had suggested that I should use Enbrel and I didn't agree because (1) my PPD test showed positive ( I don't have TB but I was told I was exposed to the infection) and I was afraid that it could cause TB and (2) I also wanted to give Salfasalazine a chance because I had never taken it regularly even for one month. My doctor said as long as I take TB-preventing medicine for one month before I use Enbrel, it should be fine. For now I can still endure the pain and discomfort without Enbrel. But since I have had a knee infammation for almost a year, maybe it has been long enough and it is time to use Enbrel to stop it??

lws3

Hi, lws3:

Do you mean NSAIDs instead of DMARDs? Enbrel is a DMARD and if the patch test shows you have been exposed to TB, you are almost certainly excluded from starting on the Enbrel, but I do not know whether this applies to Arava (an interleukin trap).

Sulfasalazine is also a DMARD, but VIOXX is an NSAID. What was your dosage and was the sulfa enteric-coated (Azulfidine--EN)?

The combination of the reduced starch regimen and enteric-coated sulfasalazine should be enough to avoid future knee swelling, but it is a good thing to investigate the potential of using the biologicals, also.

Good luck to you, and please let us know how you are doing,
John





"Any teacher who can be replaced by a machine, should be."
Isaac Asimov, 'Project Hole-in-the Wall'

Oh, I guess I was ignorant about the nature of Enbrel. I thought only drugs like Salfasalazine is called DMARDS while Enbrel is not. So I did mean the choice between Enbrel and Salfasalazine. One thing I feel confused about is that my doctor told me that as long as I take anti-TB medicine for one month before I start Enbrel, it should be fine. Have you heard of this? I waited this long just because I am afraid of the potential problems.

Could you tell me more about Arava? I never heard about that. Is it similar to Enbrel? Or to Salfasalazine?

I believe the Salfasalazine I was given is called Sulfazine EC. Is it what you are talking about? I was told that this type causes less stomach discomfort. 2000 mg a day. I don't use Vioxx very often. Before I took one pill (50mg) once every three days or so and I have stopped taking Vioxx for quite a long time.

Are you using Enbrel? Or Sulfasalazine?

Thanks for your reply.

Lws3

Hi lws3 I've been taking Sulfasalazine for awhile just started Enbrel. Doc said if it helps me I could stop taking the Sulfasalazine.

Hi, thanks for your reply. Is it because Sulfasalazine did not help much in your case? How do you feel now with Enbrel?

I have been on Enbrel for 3 months it works great for me.I had to take a TB test first was okay.I was on both Metrotrexate and sulfasalsazine.I am completely off the sulfasalsazine but still take metrotrexate.MY rheumy says I will still have to stay on MTX but is going to cut the dosage way down on my next visit.I am getting completely off prdnesone and pain killers.
Jim

Sulfasalazine is working for me I just have been on for so long that I'm always telling my Rheumatologist that I want of of it because of the stomach problems it can cause. So far I feel I'm not as stiff in the morning. I'm only on my third shot. Been heaing good things in here. Hope that helps you. Mike

Hi lws3!

I think these terms tend to get everyone all confused, but to my understanding I think Enbrel is considered and hopefully proves to be a true DMARD (disease-modifying anti-rheumatic drug) but likely longer term studies are needed for this conclusion. Someone please correct me if I'm wrong here? Sulfasalazine seems to have some disease-modifying abilities but it is not called a dmard with any consistency as far as I have read. Some papers say it is, some don't?

All I know is that you may want to give it a more serious try if you are nervous about your suitability for Enbrel. I haven't learned enough to help with your question about the TB prevention. I have taken Sulfasalazine EC (yep, that stands for enteric-coated) for over a decade with great results. The literature says it is most effective for people with peripheral joint involvement (such as your knee). But this drug takes 3 months to become fully effective, so a longer test would be needed to see if it works well for you too.

Long term, I would guess that Enbrel would be far more effective, but it is newer and therefore has an element of unknown risks to consider.

Good luck in your research, and I hope you find a solution that works and one that you can be comfortable with!

Take care,

mig

Mig, your understanding corresponds to my understanding. The term DMARD [disease-modifying anti rheumatic drug] is confusing, because drugs are given this designation of"disease-modifying" for one condition or set of conditions, but may not prove to be "disease-modifying" for other conditions. Specifically, a drug that is a DMARD for rheumatoid arthirits might not be a DMARD for AS/spondyloarthropathies:
Link to editorial from Journal of Rheumotology
The Concept of Disease Modification in Spondyloarthropathy by HELENA MARZO-ORTEGA, PAUL EMERY, DENNIS McGONAGLE
https://www.kickas.org/modification.shtml
same article is here:
http://www.jrheum.com/subscribers/02/08/1583.html

Here is a link to a recent review in the Canadian Medical Association Journal
Tumour necrosis factor- inhibitors and the reactivation of latent tuberculosis infection by Richard Long and Michael Gardam:
http://www.cmaj.ca/cgi/content/full/168/9/1153

Edited by Evelyn on 01/27/04 10:48 AM (server time).

Edited by Evelyn on 01/27/04 11:09 AM (server time).

Thanks Evelyn!

I'd never read that 3rd link before, and found it very interesting... (well, at least the parts that I understood! ) It's amazing how, slowly but surely, I'm starting to grasp the jargon enough to get the general gist.

Kudos to you for continuing to provide a wealth of reading material!

mig