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Tried nsaids and dmards, are biologics next??

Ive taken methotrexate, prednisone, sulfasalazine, numerous kenacort injections and every side effect possible over a period of a year, small improvement to aches and inflammation but had a flareup nearly every month, do I go onto tnf blockers next? My rheumatologist said my MRI has to show ive got sacroilitis in hip/lower back to move onto next treatment?? Ive stopped all meds for 3 months as had significant weight loss and bad health, take tramadol daily and vitamins. Any suggestions???

5 Replies

Hi JaneenG - I started biologic back in January this year Etanercept which has helped to some degree - I do experience the odd flare up in my foot now and again. I stopped the mtx as the mouth ulcers and stomach burning was no fun. Although I should be on a combined therapy - I think my body found it too much! Overall things have been manageable. All the best.


Yes I've done all that and more, benapali was the last one but nothing has worked for me I've got a bad tooth infection so on antibiotic, side affect of bio, waiting now to see abt having infusion but I am really fed up I just don't want to be bothered at moment


I take it your Rheumy didn't discuss which meds he's considering should you present with sacroiliitis in your hip/lumbar region? Well, it's his decision whether you're ready for anti-TNF's I would think, whether that's dependent on the MRI I guess it's not clear. If it is moving on to anti-TNF's then he will need to consider if you're presently well enough controlled on your meds, this in part depends on your DAS 28 score. Also whether you've been on MTX long enough (6 months I think unless there's some reason to not take it that long), or a combination of DMARDs at standard dose, one being MTX. Then there's the other biologics eligibility criteria to pass... once you've been off all meds for a month & your DAS 28 score is measured at higher than 5.1 taken at least twice a month apart. Then if he thinks you're eligible it's for a 6 month trial period, according to NICE guidelines.

Obviously it will be guesswork as we're all different but i've been diagnosed 10 years & I've taken HCQ, MTX, LEF & SSZ plus around 4 years of low dose steroids. I've also had general & localised steroid injections, both Kenalog (triamcinolone acetonide) & Depo Medrol (methylprednisolone). My DAS 28 score is mid range so I'm not eligible to be considered for anti-TNF/biologics even though my feet aren't included yet remain to be well controlled. Unfair because they're not included, I they were who knows I may be eligible to be tested for anti-TNF's if it weren't for them. 😒


The guidelines for moving patients on to biologics are I think a little different for those with ankylosing spondylitis than rheumatoid arthritis.

You don't say what your blood markers or recent DAS scores are but it may be that you wouldn't qualify for biologics according to the RA guidelines. So it may be that he needs to see signs of synovitis/damage on an MRI that confirms spondylitis and will justify moving you on to biologics. I think for spondylitis there are three anti-tnfs that are more commonly used.


hi janeen I have tried methotrexa t it not agree with me I hate drugs with toxic side effects even though some can be beneficial and would not advise anyone not to take them as it is personal choice I now taking low dose naltrexone toccasionlyhe only side effect is vivid dreams it is thee best choice I have ever made you can not get this from any doctor please do your research I also amprednisolone on5mg


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