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Enthesitis and COSENTYX
#283698 11/03/19 04:32 PM
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My major AS symptom is system wide enthesitis. Has anyone had good results with COSENTYX and enthesitis? I'm on humira 1x/wk (x 6months) prior q2weeks x 1yr and it's really not doing it for the enthesitis.

TIA!

Re: Enthesitis and COSENTYX
bizzylizzy #283727 11/10/19 01:59 AM
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Hi there. I can't provide an answer, but wanted to chime in since we are in similar situations. My main AS symptom apart from fatigue is enthesitis. More recently (last 6 months) I've had pain in the knees, but the enthesitis has been gong on for years. We are also doing the same treatment. I am on month 5.5 of Humira with no results. I am now switching to Cosentyx. My rheumy believes that Cosentyx is particularly effective for enthesitis and I have heard the same around AS message boards, but I can't find hard data to support the idea that Cosentyx is more effective for this particular symptom than other medicines.

I am planning to do about a month more of Humira just to totally rule it out, and will the start Cosentyx (4x month for 1 month for loading doses, then 1x month thereafter) if I see no results. It would be great if we could stay in contact since our cases are so similar.

I am so hoping Cosentyx will be the answer for you! Good luck smile

Last edited by KatherineL16; 11/10/19 02:00 AM.

Diagnosed AS. HLAB27+. Naproxen, indomethacin, meloxicam, and ibuprofen failed. On Humira (first anti-TNF) since July 2019 with no result so far.
Re: Enthesitis and COSENTYX
bizzylizzy #283737 11/11/19 06:50 AM
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Hello everyone... I hope my question does not seem silly but have you tried sulphasalasine? They say that for enthesitis sulphasalasine is better that methotrexate...I undrestand that you have already used biological treatment but, in the begginning, doctors did not prescribe sulphasalasine?

Generally speaking, from my little experience, heel pain - enthesitis is almost uncurable... it never stops...

Re: Enthesitis and COSENTYX
KatherineL16 #283741 11/11/19 05:54 PM
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@KatherineL16--I think that would be great to stay in touch and compare notes as we try to figure this out! I'm going to try to get into a teaching hospital rheumatologist so I can be around folks that are getting the first info on new treatments.

@momchrisgr-I tried sulphas years ago-it was a no-go. Zero effect after 6 months. Interestingly I had to request it. I ALWAYS have to request my med changes. It's frustrating.

Thanks you guys!

Re: Enthesitis and COSENTYX
bizzylizzy #283745 11/11/19 09:06 PM
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After being on Humira and Enbrell for a few years I changed over to Cosentyx some 9 months ago.
Working pretty well so far for both the enthesitis and arthritis. Upped the dose to 300 mg/month due to waning efficacy at the end and beginning of each month and it's helping.
No magic wand. Still take NSAIDs almost every day but feel better and more functional.
Good luck

Re: Enthesitis and COSENTYX
momchrisgr #283746 11/11/19 09:12 PM
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Hi @momchrisgr, not silly at all. After the anti-inflammatories failed, I brought up trying methotrexate or sulfasalazine before starting biologics, but my rheumy said they would not be helpful for my case. I just checked to see if I could find literature to back that up, and found this study: https://www.ncbi.nlm.nih.gov/pubmed/16583475. The conclusions echo what she had told me: "Across all patients with AS, SSZ showed some benefit in reducing ESR and easing spinal stiffness, but no evidence of benefit in physical function, pain, spinal mobility, enthesitis, or patient and physician global assessment. Patients at an early stage of disease, with higher level of ESR (or active disease) and peripheral arthritis, might benefit from SSZ."

Every body is different, though. Did SSZ do anything for you?


Diagnosed AS. HLAB27+. Naproxen, indomethacin, meloxicam, and ibuprofen failed. On Humira (first anti-TNF) since July 2019 with no result so far.
Re: Enthesitis and COSENTYX
bizzylizzy #283748 11/12/19 12:32 PM
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hi KatherineL16, No, Chris has not started sulpha yet, but rheumatologist has already decided it, we just wait for some results (calprotectine...anyway). What he already has done is 6 weeks of naprosyne (during August and September) but did not work and... prp... in other words: Platelet-rich plasma. Platelet-rich plasma was a waste of money for us. He did it twice, first time at the end of last May and then in the beginning of July. Although he suffers pain without complaining a lot, after this procedure he was in great pain for about a week or so. What a silly decision... such a failure... did nothing at all...
From what I have read, enthesitis is very difficult to cure. First of all, if you inject cortisone in the heel, you can have the Achilles tendon ruptured.
If you have enthesitis in the knee ( Osgood Schlatter) you cannot take cortisone injection.... Dead end...

Re: Enthesitis and COSENTYX
bizzylizzy #283783 11/20/19 02:03 AM
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SSZ can be helpful for peripheral symptoms and even sometimes for axial symptoms but like any of the meds, it's very hit or miss and works for some, does nothing for others. The quality of most of the published research on SSZ is quite low so it's hard to draw any conclusions from the research. At the end of the day, it's a fairly safe and very cheap med so it's worth talking to your doc about trying it.

I have a great response to it but it gives me itchy skin so rheum has recommended starting Cosentyx. I was doing some reading on it and thought that I read somewhere they were seeking approval for something more related to peripheral symptoms but can't seem to find it now. It seems like for all of these, unfortunately, you kind of have to try it and just see how it works in your body : /

Last edited by Ucla08; 11/20/19 02:03 AM.

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