Biologics for Ankylosing Spondylitis: Everything you should know

If you are suffering from Ankylosing Spondylitis/ AS then you must know about biologics. Biologics are a newer type of medicine which is effective in people with moderate to severe Ankylosing Spondylitis who have not responded to other treatments.  

If you are one who has tried all kind of treatment but not improving then you may consider reading further.

You might be wondering what it’s a physiotherapy blog and we are talking about medicine. Actually, I have a client with Ankylosing Spondylitis to whom I am giving physiotherapy. He is also taking biologics along with physiotherapy.

Biologics for ankylosing spondylitis

I have seen improving his conditions which made me share it with you all via this blog. My client is a 28-year-old male suffering from Ankylosing Spondylitis since last 9 years. Luckily he has not developed any serious bony changes like bamboo spine, joint fusion except a problem in hip joints.

He has developed narrowing of joint space in both the hip joint. Recently he visited a rheumatologist who suggested him biologics. He was prescribed with 6 dosages of it. By the time I am writing this post he had already received 3 doses.  

But, before proceeding to biologics let us discuss little Ankylosing Spondylitis.

What is Ankylosing spondylitis? 

The name ankylosing spondylitis comes from the Greek word “ankylos.” meaning stiffening of a joint, and “spondylo,” meaning vertebra. Spondylitis refers to inflammation of the spine or one or more of the adjacent structure of the vertebrae.  

Ankylosing spondylitis is a chronic disease which is characterized by progressive inflammation and stiffening of the joints and is a form of arthritis.  

Who is affected?

If you are suffering from Ankylosing spondylitis, let me tell you that you are not alone. There are up to 65 million people worldwide who have the condition, including almost 5 million people diagnosed with as in Asia.

Most people first develop Ankylosing spondylitis between the age of 15 and 40 years. It is about three times more common in men than in women.

What are its common symptoms? 

1. It starts with pain on the lower back. Slowly it spreads to the whole of the spine. Pain flares up especially in the morning and often during the night (usually in the lower back, but often up to neck).
2. As the disease progresses pain and stiffness start developing in multiple other joints (eg knees, ankles, hand and feet)that get wore with rest and can improve with activity.
3. Persisting pain for more than three months, and continuing for life.
4. The severity varies from person to person, and not everyone will experience the most serious complications. Some will experience only intermittent back pain and discomfort but otherwise will experience severe pain and stiffness over multiple areas of the body for long periods of time.
5. Ankylosing spondylitis is usually characterized by acute, painful episode followed by temporary periods of remission where symptoms subside.

What is Biologics?

A biologic is different from other medicines. Unlike other medicine, these are not chemicals, it is a type of medication that is created inside a living cell and this is why it is called biologics.

It is created by changing the DNA of certain cells. They are changed so that they are programmed to replicate themselves indefinitely time. They are also programmed so that they can produce a desired antibody inside the body.

A biologic used for treating Ankylosing Spondylitis is programmed to produce antibody against tumour necrosis factor (TNF).

How it works in our body?

Biologics is TNF blocker (inhibitors) which blocks TNF. Tumour necrosis factor (TNFα, tumour necrosis factor alpha) is a signalling protein (cytokine) which is believed to be responsible for systemic inflammation.

A recent study conducted on 8000 psoriatic arthritis sufferer taking TNF inhibitors has shown that there is no increased cancer risk with TNFi treatment as compared to general population

TNF in controlled amount is beneficial to our body, but in Ankylosing spondylitis sufferer it is found in excessive amount. This results in inflammation in Ankylosing Spondylitis.

Biologics have been shown to be quite effective in treating ankylosing spondylitis (AS) in many people. They are designed to target these TNFα of the immune system.

Biologics acts by producing an antibody which blocks/ inhibit the action of these inflammatory TNFα. In this way, biologic can reduce inflammation and the resulting tissue damage and improve disease symptoms for many people who take them.

Is biologics right for me?   The doctor will decide for taking many thing into consideration. So consult your doctor about the biologics.  

Final words

Remicade (infliximab) is the brand name of biologic which my patient received. It was given through injection. Like any other medicine it has its own side effect. But one of the major drawbacks is its cost. A single dose of injection cost him around 17000 INR.  

Keep Reading: 11 Ulitmate Ankylosing Spondylitis Exercises and Home Tips

Source: www.spondylitis.org

Sunit. S. Ekka

Dr Sunit Sanjay Ekka is a physiotherapist in practice for the last 15 years. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. The patient is his best teacher and whatever he gets to learn he loves to share it on his Youtube channel and blog.