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Re: Are tnf that bad? [Re: Winston] #282465
01/19/19 06:39 PM
01/19/19 06:39 PM
Joined: Jan 2019
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Originally Posted by Winston
The AS treatment guidelines state with respect to sulfasalazine and drugs like sulfasalazine:

"In adults with active AS despite treatment with NSAIDs, we conditionally recommend against treatment with SAARDs (PICO 7; very low- to moderate-quality evidence, depending on the drug; vote 90% agreement). Evidence and rationale. Evidence on the efficacy of SAARDs was based on controlled trials of sulfasalazine
(n 5 8), methotrexate (n 5 3), leflunomide (n 5 1), pamidronate (n 5 1), thalidomide (n 5 1), and apremilast (n 5 1) (see Supplement E: Evidence Report, availableon the Arthritis & Rheumatology web site at http://onlinelibrary.wiley.com/doi/10.1002/art.39298/abstract). The quality of evidence for critical outcomes was moderate to very low. Sulfasalazine had a small beneficial effect on spinal pain but not on other outcomes, and had a higher risk of side effects than placebo. Although treatment with sulfasalazine did not improve peripheral joint counts, small benefit was seen in a composite measure of peripheral arthritis symptoms. The other medications were tested in small numbers of patients. Trials of methotrexate were limited by use of weekly doses of 10 milligrams or less. Treatment with high-dose pamidronate was associated with improved patient-reported outcomes compared to low-dose pamidronate and deserves further study. Based on a very low to moderate level of evidence of small or no clinical effects, the panel recommended against the use of SAARDs in most patients whose AS remained active despite NSAID
use; treatment with TNFi would be recommended instead (see PICO 6 below). Treatment with sulfasalazine or pamidronate could be considered for patients with contraindications to TNFi or those who decline treatment with TNFi. Sulfasalazine could be considered for those with prominent peripheral arthritis."

See https://www.rheumatology.org/Portal...ment%20of%20Ankylosing%20Spondylitis.pdf


I wonder how many of those doctors who pushed for biologics in this study received something from drug companies. https://projects.propublica.org/docdollars/


1986 lower back pain going down leg
1990-1993 iritis attacks in left eye
1993 diagnosed with AS by x-ray (spine squaring, hip damage) & HLA b27 gene
1993-2002 iritis attacks rt eye about every year
2002-2019 meds=2000mg sulfasalazine, 400mg celebrex, 5mg prednisone, no iritis, exercise lift weights and arthritis swim class
2017-2019 yoga twice a week
2019 x-ray spine squaring, L5 fused, spinal stenosis
Re: Are tnf that bad? [Re: worldofme] #282466
01/19/19 06:57 PM
01/19/19 06:57 PM
Joined: Jan 2019
Posts: 10
Netherlands
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Here in the Netherlands I don't think doctors are very pushy about biologics. My rheumatologist hasn't even brought them up yet. We have mandatory health insurance, with basic coverage that is the same for everyone. Humira is covered by it, but it's by far the most costly drug for the insurance companies (although this was before the 80% price drop). I assume the insurance companies keep the pressure on doctors to exhaust other treatments first. Generic NSAIDs and physical therapy are much cheaper than biologics.


Medication: Arcoxia 60mg as needed
No official dx yet (no visible fusion of SI joints on x-rays)
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