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Re: Sulfasalazine for Peripheral AS [Re: achala] #283619 09/24/19 05:40 PM
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RAHMBA Offline
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"... my rheumy, says for AS I wont get Humira because my CRP is <15 (protocol), …"

I wasn't aware of this protocol. it seems strange to me. AS is a clinical diagnosis. in the USA, SSZ is not indicated to treat AS. but TNFs are indicated to treat AS. If not managed by NSAIDS, then I would think a biologic would be offered to you.

Treatment guidelines:
https://www.rheumatology.org/Portals/0/Files/AxialSpA-Guideline-Early-view-2019.pdf

info:
https://www.spondylitis.org/Treatment-Information

https://www.spondylitis.org/Medication-Guide


AS, U C, Iritis, migraines. HLA-B27neg. Yoga (instructor) & spin. No meds at this time. Dx 1989. SAA member/donor since 1993. All my posts are personal opinion/feelings and do not represent the SAA. Help find a cure & support others by donating to the SAA.
Re: Sulfasalazine for Peripheral AS [Re: RAHMBA] #283651 10/06/19 01:02 AM
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Sean O Offline
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Originally Posted by RAHMBA


I wasn't aware of this protocol. it seems strange to me. AS is a clinical diagnosis. in the USA, SSZ is not indicated to treat AS. but TNFs are indicated to treat AS. If not managed by NSAIDS, then I would think a biologic would be offered to you.

Treatment guidelines:
https://www.rheumatology.org/Portals/0/Files/AxialSpA-Guideline-Early-view-2019.pdf

info:
https://www.spondylitis.org/Treatment-Information

https://www.spondylitis.org/Medication-Guide


The guidelines you quote from 2019 in Table 2, Recommendation 4 seems to say SSZ is appropriate sometimes for peripheral arthritis. I may get it because peripheral arthritis is a growing problem for me as well.


Male, early 50s, Dx AS+ 1991, HLA B27+, Tylenol 3 PRN for flares. Off NSAIDs due to stomach issues. Considering a biologic. SI and thoracic involvement and costochondritis. Many bouts of uveitis. Small bowel issues, anemia.
Re: Sulfasalazine for Peripheral AS [Re: RAHMBA] #283686 10/26/19 01:03 PM
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achala Offline
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Originally Posted by RAHMBA

"... my rheumy, says for AS I wont get Humira because my CRP is <15 (protocol), …"

I wasn't aware of this protocol. it seems strange to me. AS is a clinical diagnosis. in the USA, SSZ is not indicated to treat AS. but TNFs are indicated to treat AS. If not managed by NSAIDS, then I would think a biologic would be offered to you.

Treatment guidelines:
https://www.rheumatology.org/Portals/0/Files/AxialSpA-Guideline-Early-view-2019.pdf

info:
https://www.spondylitis.org/Treatment-Information

https://www.spondylitis.org/Medication-Guide


Here in Romania, I would have to have CRP > 15 to qualify for protocol. Otherwise they offer me something called Cyclosporine (with plenty of side effects obviously).
In this 2 years period, since diagnosis, I was able to fix the left retro calcaneus bursitis/enthesistis, back pains, shoulder pains etc - I am able to touch the floor with straight legs!
Problem is still with anterior uveitis after coming off sulfasalazine. I am on predonisone 32 mg for the next 2 days coming of 16 then 8 for 4 days each. Here in Romania protocol doesn't support the 4mg follow up, which in any case I tried when the recent flare started with no success.

I tried, quality curcumin with 30 time over enhanced bio availability 2 x per day 375 mg, with no success so far. Bought a tonne of Matcha, rosehip, nettle...

From what I read, IL-6 is responsible for Uveitis (not solely of course), not sure if also anterior. would you recommend any papers/materials to read about the etiology?
I found couple of interesting ones today:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597169/#R67
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603543/

Warm regards

Last edited by achala; 10/26/19 02:24 PM.

diagnosed with AS April 2018, starting with cervical pain/stiffness; Aug 2018 enthesitis/bursitis left Achilles
diagnosed with AAU Nov 2017 (7 flares so far)
Eosinophilic Gastritis
Sulfasalazine 3g 08.2018-05.2019 (worked for AAU & peripheral)
Supplements:C/D, omega 3/Probiotic/ Mediterranean NSD/curcumin
swimming/yoga/pilates
Predonisone in case of another AAU flare
Re: Sulfasalazine for Peripheral AS [Re: achala] #283690 10/29/19 02:37 PM
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Originally Posted by achala
From what I read, IL-6 is responsible for Uveitis (not solely of course), not sure if also anterior. would you recommend any papers/materials to read about the etiology?


I probably had 30+ episodes of uveitis over a period of 15 years (1993-2008). The uveitis was associated with reactive arthritis.

In 2008, I was diagnosed with polymyalgia rheumatica (PMR). IL-6 is thought to be responsible for PMR and is usually treated only with corticosteroids. When I was taking prednisone daily, I didn't have any episodes of uveitis from 2008 until this year.

This year, I was started on Actemra (tocilizumab) to treat PMR and it worked very well. I came off prednisone and was pain free for 5 weeks. Actemra is a prescription medicine called an interleukin-6 (IL-6) receptor antagonist. Actemra didn't seem to work for uveitis because I had a severe flare of panuveiits. I recently saw a uveitis specialist who wanted to try Humira since it is approved for uveitis.

I found the following article interesting:
https://www.reviewofophthalmology.com/article/the-latest-treatment-approaches-for-uveitis

I don't know what I will do now because the PMR pain and stiffness has returned on Humira. I would like to try Actemra for PMR and low dose prednisone for uveitis. I don't know what role reactive arthritis is playing in all this.



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