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Learning about your treatment options is one major aspect of managing a chronic condition that causes spinal inflammation, such as ankylosing spondylitis. It can also be really frustrating since you may need to try several treatments before finding something that helps relieve your symptoms.
You might be interested in taking biologics, a type of medication that targets your body’s immune system to lower inflammation. Generally, doctors recommend biologics for ankylosing spondylitis when you’ve already tried nonsteroidal anti-inflammatory (NSAID) drugs and your symptoms haven’t improved, according to Dona Poulose, M.D.,1 assistant professor of allergy, immunology, and rheumatology at the Baylor College of Medicine.
There are numerous types of biologics, and the right medication for you depends on several factors—including what exactly is causing your spinal inflammation. If you are interested in taking biologics, it’s important to understand what your treatment plan may involve, and how it can help you manage your symptoms. Here are some questions about biologics that you might find helpful to ask at your doctor appointment.
1. Which biologic would you recommend for me and why?
After determining that you’re a candidate for biologics, your doctor may suggest a few for you based on several factors, according to Orrin Troum, M.D.,2 rheumatologist at Providence Saint John’s Health Center in Santa Monica. For many people, insurance coverage is a big determinant. “I may like someone to use a particular medication because others have had good experiences with it, but if their insurance coverage is going to make it difficult, we’ll try something else,” Dr. Troum tells SELF. (If you don’t have health insurance or if your insurance doesn’t cover biologics, then you can contact the drug manufacturer to ask about patient assistance programs, which can help cover some of the medication cost.)
Your doctor will also factor in whether you have any comorbidities or allergies when selecting your biologic, Dr. Poulose says. (Some medications may work better or be safer in people with certain other health conditions.3)
2. What are the side effects of taking this biologic?
You want to have a clear understanding of the possible risks that come with taking medications, so it’s worth asking about side effects if your doctor doesn’t bring them up.
Biologics are administered either through an intravenous infusion or injected under the skin, so you may experience pain and swelling around the injection site, according to the Johns Hopkins Arthritis Center.4 Reactions around the biologic injection site are the most common side effect; however, you may also develop infections more easily when using these medications.
There’s no way of knowing how you might react to a medication. But if you’re worried about side effects, you can ask your doctor questions that can give you some perspective such as:
- How can side effects affect my daily life?
- What can we do if my side effects are worrisome?
- What are the most common side effects you see in other patients?
3. Will I need any additional treatments?
You might assume that taking a biologic is the only treatment that you’ll need, but that’s not always the case. For example, some people with ankylosing spondylitis may find that physical therapy can be a really helpful addition to their medication, according to Dr. Poulose. “Physical therapy is vital to preserve mobility and help prevent stiffness,” Dr. Poulose tells SELF. In physical therapy, you might walk, stretch, and even try new sleep positions that help preserve your posture. Depending on your particular condition and symptoms, your doctor may also prescribe additional pain medications such as corticosteroid injections, Dr. Troum says.
4. What kind of progress can I expect?
This is hard to predict, but it’s still a good question to ask. “Not every patient responds the same to every medication,” Dr. Poulose says.
That said, your doctor should be able to explain how the biologic can help ease your symptoms and in what time frame, according to Dr. Troum.
And you can ask your doctor about when you should follow up if your symptoms haven’t improved. You may need to take a biologic for several months before you see any benefit, so it’s a good idea to set clear expectations with your doctor about what to expect.
5. Can I achieve remission with this biologic?
Generally, you take biologics with the hope of achieving remission, meaning you have no symptoms or very few symptoms, according to Dr. Poulose. However, there is no guarantee that this will happen for everyone—so you need to discuss with your doctor whether this is possible for you. “It is important to remember that remission may not be achievable in every patient because every patient and their disease activity can be different,” Dr. Poulose says. If you get diagnosed when your disease has severely progressed, then it may be harder to achieve remission, she explains.
Biologics are very effective, and the right one should help you move toward your goal of living a more comfortable life, according to Harvey Smith, M.D.,5 chief of orthopedic spine surgery at Penn Medicine. In some cases, biologics may be able to stop the progression of a disease.
6. How will I know if my biologic stops working?
It’s possible that your medication can gradually become ineffective over time. That’s why your physician will likely recommend routine blood work to monitor for certain biomarkers that indicate inflammation and disease activity so you can proactively keep tabs on your condition, Dr. Smith says. However, you can't always detect serologic markers of inflammation with ankylosing spondylitis and axial spondyloarthritis, which is why it's important to have follow-ups with your rheumatologist too.
You might also notice an increase in symptoms, he says. That can vary by person, but some of your initial symptoms at the time of your diagnosis might reappear. For example, if your back was always stiff when driving, then that might happen again. In that situation your doctor would reevaluate your condition and either prescribe another biologic or suggest including additional treatments, like NSAIDs, targeted physical therapy, or other pain relievers, Dr. Poulose says.
You may be really unsettled if your medication stops working, but know there are likely other options available to you if that happens. Keep in mind that your treatment options may change over time based on new research and newly available therapies. Make sure you have ongoing conversations with your doctor about which treatment options may be best for you.
7. Are biologics safe if I want to conceive?
Biologics are long-term medications, so if you know you’ll want to try to get pregnant at some point, it’s important to tell your doctor that up front, Dr. Troum says. Some medications can cross the placental barrier; in other words, they can reach the fetus when you’re pregnant, so some biologics may be safer during pregnancy than others.6 If you want to become pregnant or are pregnant, it’s important to let your doctor know that so you can choose a biologic that’s best for you or pick an alternative treatment.
Sources:
- Baylor College of Medicine, Dona Poulose, M.D.
- Providence Saint John’s Health Center, Orrin Troum, M.D.
- American Journal of Clinical Dermatology, Biologic Treatment Algorithms for Moderate-to-Severe Psoriasis with Comorbid Conditions and Special Populations: A Review
- Johns Hopkins Arthritis Center, Side Effects of Biologic Medications
- Penn Medicine, Harvey Smith, M.D.
- Frontiers in Pharmacology, Drug Interactions at the Human Placenta: What Is the Evidence
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