Spondylitis Drug Choice

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New Member

Date Joined Feb 2007
Total Posts : 1
   Posted 2/28/2007 2:06 PM (GMT -6)   

Hi All. I am new to this group today. This Monday I was diagnosed with Undifferentiated Spondyloarthropathy. I'm 45, have had increasing pain in my spinal joints for a couple of years now and finally thought wow, I have chronic pain perhaps I should look into that. My family practice physician referred me to a rheumatologist (not my first rheumatologist; I've seen many over the past 20 years always with a diagnosis of vague symptoms) who he respected as a good diagnostician. She did a battery of tests and examinations and feels that the diagnosis is an obvious one. Over the years, I've taken months to years of a variety of NSAIDs. They really don't do much to improve things over time and with many of them I've had noticeable side effects - headaches with Indocin, metal taste with naprosyn, etc.

This rheumatologist gave me information about pursuing treatment with a couple of different options. Her choice would be Sulfasalazine, but she also gave me information on Plaquenil and Methotrexate. I believe these are all DMARDs? I understand the meaning of that. She also approached taking Enbrel so I have read the information about that.

So my question is how in the world do you decide what course to try?

The newer drugs have that unknown factor but at the same time, the old ones don't seem to stop the progression of damage from the disease. What things have you all tried? How have your side effects been? How have they worked?

I open to hearing from as many people as possible in great detail. I am an information gatherer so I do want to make an informed decision.


Veteran Member

Date Joined Mar 2005
Total Posts : 3199
   Posted 2/28/2007 6:35 PM (GMT -6)   
Hey Kelly.. welcome to Healing Well! Hhhmm interesting question you have.. I wasn't given a choice by my rheumy.. when I got diagnosed he told me "We're going to start you on Enbrel, and if you don't tolerate that, we'll try something else.. " I know personally speaking, for me, Enbrel has been a godsend.. but I've not been on MTX or Plaquinel or Sulfasalazine.. I have been on pretty much ever NSAID out there though.. and they have done little to nothing for the pain.. I know with Enbrel, it has helped with the pain/swelling/redness and progression of the disease.. I'm sure it hasn't stopped it.. but it has slowed it down a great deal.. If you have any questions, please feel free to ask.. I'm looking forward to your posts..

Moderator of Arthritis/Epilepsy Forums
Confirmed Diagnosis of - Psoriatic Arthritis/Spondylitis/Graves Disease/GERD/Scoliosis/Hiatal Hernia/Graves Disease of the Eyes/Chronic UTIs
Current Meds -  Enbrel/Prevacid/Synthroid/Nitrofurantoin
Past Meds - Inderal/PTU/Prednisone/Voltaren/Feldene/Mobic/Cortisone and Steroid Shots
Additional Supplements - Multi-Vitamin/Bromelian/Acidophilus/Green Tea

Veteran Member

Date Joined Nov 2003
Total Posts : 7314
   Posted 2/28/2007 9:40 PM (GMT -6)   
I am allergic to sulfa, so sulfasalazine was never an option for me. I outright refused methotrexate because of the risks regarding pregnancy and I hope to get pregnant soon. I was never offered plaquenil.

My Rheumy wanted me on Remicade when I was first Dx. I also have Crohn's, which was under control at the time and I was concerned that if I started Remicade then, that I wouldn't have the option of using it later, if I needed it for my gut. I was also pretty worried about the likelihood of an allergic reaction or antibody reaction to the murine protein. I can be very sensitive to meds that way. We debated the pros and cons of the biologic in general and I decided that I'd prefer to avoid them.

Three months later, barely able to walk, I returned and told the Rheumy that if biologics were my only option, I'd try Enbrel. I made that choice because my Crohn's was still under control and the other options, Remicade and Humira, are also used for Crohn's. I used the Enbrel for 14 months and did see some improvements between month 2 & 3. Unfortunately, I had some other medical problems which made a real improvement impossible to attain. Then, my insurance changed and so I needed a new Rheumy.

I saw 3, but none of them would script Enbrel and so I've been without treatment for the last 18 months. I just switched Docs again and the ne one has scripted Humira. Now, my Crohn's is no longer in control and I need the benefits of a med to treat both diseases. I chose Humira this time because it's more convenient for me to self inject instead of having to go in for infusions. It's just a matter of convenience for me.

I hope that whichever meds you choose bring you significant relief.
Keah a.k.a. Wormy
 God helps those who help themselves.
Please help us support this invaluable forum.
Crohn's Forum Moderator

Veteran Member

Date Joined Dec 2005
Total Posts : 1782
   Posted 3/1/2007 1:15 AM (GMT -6)   
When I was first diagnosed with RA, I was scripted Plaquenil. Best thing since sliced bread, only problem it was quite expensive 15 years ago. The medical group I was with prescribed it, but it wasn't in their formulary, so I had to pay full price. I stopped taking it and should have bought stock in the company that produces ibuprofen.

When I was diagnosed with AS almost 4 years ago, my rheumy immediately put me on Enbrel for the AS & RA. Worked great until I had one humdinger of a dental infection. Lost some of its effectiveness, so we added methotrexate to the mix. Both worked great. Last year, I was diagnosed with Crohn's. Unfortunately, Enbrel really isn't a biologic for IBD's, so I was switched to Remicade which covers all three. He had me continue the methotrexate as well. Works fab for my AS & RA - so so for the crohn's.

It's a quality vs. quantity of life issue for me. I've discussed all of my med choices with my husband and doctors and feel I need to do what I can to have a life that I'm accustomed to. Do I like taking these? Nope. I do however, consider (and remember) the alternatives, so here I am. So far, so good (although my Crohn's isn't under the control I'd really like).

Bear in mind that all med's have side effects - even baby aspirin. That doesn't mean you're going to have any or all of them. I experienced nausea and hair loss/thinning with the methotrexate, so we upped my folic acid (an absolute must to take with mtx) and switched me to the injectible form. That helped immensely and the side effects went away. Other than that, I've experienced no other side effects from the Enbrel or the Remicade (knock wood).

If you're offered a biologic -- take it. Why start at the bottom with experimenting, when you can start at the top and start stopping the damage from getting worse? It's certainly no cure, but it's the best thing we have right now. That's my rheumy's opinion and I respect him immensely.

I wish you luck -- it's tough making these decisions.
"My "Trifecta" - CD, AS & RA...

Co-Moderator Crohn's Forum

Remicade every 6 weeks, Methotrexate weekly, Folic Acid daily

Veteran Member

Date Joined Mar 2005
Total Posts : 3148
   Posted 3/1/2007 8:18 AM (GMT -6)   
dear Kelly,
welcome to HW!  so glad you found this site.
you already got a lot of really great info from the above,  hope it helped.
"how does one decide what course to choose?"
this decision can be made easier by knowing that you can try MANY courses of different combos of meds!
depending on how severe the joint pain & disease process is, may help stear you in which way you want to go.
if it is very very debilitating & you're having mobility issues...more agressive treatments might be best (like the TNF meds in combo with DMARDS)
or, one way which is very popular...is to do a combo therapy of a Biologic or BRM drug & a dmard.  you'll see many people on MTX and plaquenil; or MTX and Enbrel; Imuran is also a very popular med for arthritis too.
the good thing is that a person can kinda do a trial and error sort of thing...which is how a lot of people end up sticking with that one combo that works alright.
if you go ona treatment plan, give it 6months...if you're not pleased, the meds or doses can be changed.
how has your rheummy guided you in deciding a medication regimen?
Arthritis Forum Moderator
Active Severe Rheumatory Arthritis. Crohns Disease. A.Chiari Malformation & right brain venous anomoly. Partial Complex Seizures (under control!). MVP & Tricuspid Valve Prolapse. Rheumatic heart & lung. Previous Lymes Disease for 10 years.
Meds: Remicade infusions 300mg Q3weeks; Intra-articular knee injections when needed; Mercaptopurine 50mgQD plus 75mg weekly; Mesalamine 4GramsQD; Prednisone 10mgQD mantainance; Entocort 9mgQD; Meclizine; Augmentin; Tigan 300mg; Reglan; LidoDerm Patches; Diazepam 5mg for AS back spasms; Rozerem 8mg; Dilaudid 4mg tabs for pain. 

Regular Member

Date Joined Nov 2006
Total Posts : 173
   Posted 3/3/2007 4:31 PM (GMT -6)   
My Rheumy insisted on enbrel immeadiatly after he saw my X-rays. I am so thankful for this drug seeing that I am 22 and for the first time in six years i'm waking up without pain and stiffness and I can do normal things like bend over, rotate my neck, tie my shoes.
Zach - 22 y/o college student and business owner
Diagnosed UC 8/06, AS 1/07
Currently: Waiting to start Imuran if tests check OK
Back to Pred 40 mg/day (plenty of relief, thankfully)
Asacol 12/day (4.8g/day) (no distinguishable relief)
Rowasa 1,000mg suppository at bed time (so far minimal relief)
Enbrel once weekly for AS (so far awesome!)

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