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Re: Are tnf that bad? [Re: worldofme] #281906
10/29/18 05:14 PM
10/29/18 05:14 PM
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Winston Offline
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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

Re: Are tnf that bad? [Re: worldofme] #281907
10/29/18 06:13 PM
10/29/18 06:13 PM
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I am currently taking methotrexate every Tuesday. I was under the understanding that this helps in cooperation with my Remicade. If I am reading this right, it does not. I have my next round of treatment on Friday. Should I talk to my Doc about going off the med?

Re: Are tnf that bad? [Re: worldofme] #281908
10/29/18 06:21 PM
10/29/18 06:21 PM
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perhaps then in my case are the reishi mushrooms....
for me the most important is to stop uveitis, now I can work with exercises. I still agree with Winston (although the excerpts from the paper are somehow contradictory) but there is some progress without anti tnf at the moment
I forgot to write in my signature the vinegar drink 4 times per day. Maybe this is working???

Last edited by achala; 10/29/18 06:29 PM.

diagnosed with AS April 2018, starting with cervical pain/stiffness; Aug 2018 enthesitis/bursitis left Achilles
diagnosed with iridociclitis Nov 2017 (4 flares so far) - bilteral, DES
Eosinophilic Gastritis
Signs of inflammations/erosions on MRI`s for axial and Achilles/calcaneus + bursitis
Naproxen (occasionally), Sulfasalazine 3000 mg per day
Supplements: vit A&D, reishi mushrooms, fish oil/probiotic/ Mediterranean NSD
plenty of swimming
Re: Are tnf that bad? [Re: worldofme] #281909
10/29/18 07:26 PM
10/29/18 07:26 PM
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Your doctors likely have good reasons for prescribing DMARDs (what the treatment guidelines call SAARDs) in your individual cases. But I think anytime a doctor's treatment deviates from treatment guidelines you should have a conversation about it.

Re: Are tnf that bad? [Re: worldofme] #281910
10/29/18 08:36 PM
10/29/18 08:36 PM
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Notice the last sentence from Winston's quote: " Sulfasalazine could be considered for those with prominent peripheral arthritis." The same can be said for Methotrexate. This is why my rheumy started me with Methotrexate first.

Methotrexate is also sometimes prescribed along with Remicade or Humira to address or perhaps prevent antibodies from developing. Enbrel is less likely to cause the body to develop antibodies, so Methotrexate is less likely to be prescribed along with it. I have not researched the likelihood of antibodies with the newer medications.

I agree with Winston that you should have a conversation with your rheumy to understand the purpose of each medication you are taking.



Ginny - 58 year old female
Dx with USpA in March 2013; changed to AS in July 2015
Iritis and Scleritis
unicompartmental knee replacements: right-June 2014, left-Aug 2018
MTX, Humira, Cyclobenzaprine, plus Celebrex as needed
Supplements: Folic Acid, Vitamin A, Vitamin D, Calcium, Fish Oil, Culturelle probiotic, Melatonin (as needed)
Re: Are tnf that bad? [Re: worldofme] #281912
10/30/18 02:01 AM
10/30/18 02:01 AM
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worldofme Offline OP
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I have talkes to them about sulfa and he keeps telling me it won't help axial arthritis. I assume this is spine and hip. I also told him I have an active prostate infection is tnf still good. He said yes or I will have severe joint issue.

He said I should continue my abx for prostate along with tnf.

I don't really know what to do. I don't want sepsis or something serious. I don't trust doctors.

Re: Are tnf that bad? [Re: worldofme] #281914
10/30/18 11:12 AM
10/30/18 11:12 AM
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If you have a prostate infection, you might be interested in reading about the Catterall–King hypothesis.

"In 1959, Catterall and King postulated a common sexually acquired infectious etiology for all spondyloarthritis types, whose primary focus in men is the prostate" - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895656/

Re: Are tnf that bad? [Re: worldofme] #281956
11/04/18 12:56 AM
11/04/18 12:56 AM
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worldofme Offline OP
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Thanks that was an interesting paper. I mean i have try several abx and is doing nothing. My next round is ceftin or something along that line.

The problem is while I'm treating my abx i may have having joint damage.

I'm also thinking about starting enbrel i have it in fridge I just can't find tur courage after what i went through with humira.

I am also sick of trying abx. I been on doxy for 6 months it helps somewhat with pain.

I don't see any other treatment for ReA/AS other than NSAID ( raises my bp), TNf ( may cause infection ) , and Sulfa ( doc says it won't work for spine ).
.
Anything i am missing?

The IL drug someone mention here do you not get widespread infection like TNF?

Also, humira i took for 3 months did not stop my back pain completely .

Re: Are tnf that bad? [Re: butters] #281961
11/04/18 11:08 PM
11/04/18 11:08 PM
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Originally Posted by butters
If you have a prostate infection, you might be interested in reading about the Catterall–King hypothesis.

"In 1959, Catterall and King postulated a common sexually acquired infectious etiology for all spondyloarthritis types, whose primary focus in men is the prostate" - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895656/

Thank you very much, very helpful link


My name is Stan. I live in Philadelphia, United States. I am 42 years old father of one beautiful kid and I work as a software developer. I speak English and Russian languages.
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