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Tracey asked...

I have ankylosing spondylitis.

Hi there, I have ankylosing spondylitis and my specialist has recommended I start enbrel.

I'm really not keen because of the increased cancer risks. There is a strong close family history. I'm also not keen about feeling sick every week or the infections but I'm worried about how my flares and pain can be controlled if I don't have it because the last steroid injection I had in flare didn't have any effect.

I'm taking etoricoxibs, but if I'm honest they are not as effective any more. I don't know what to do. I am a carer so need to stay well, without lots more time off work for appointments. What should I do?

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The answer

Hi Tracey,

We appreciate that this must be a dilemma for you. It is difficult for you to be a full time carer with this condition. 

As I’m sure you are aware there is no cure for ankylosing spondylitis (AS) but the condition can be managed well with medication and regular exercise.

As you have had little benefit from the Etoricoxib, a non-steroidal anti-inflammatory medicine (NSAIDs), and the treatment with the steroid injection has not provided relief the choice of other medication is limited.

Medications in the TNF-alpha antagonists group such as Enbrel (Eternacept), Humira (Adalimumab), and Simponi (Golimumab), otherwise known as biological therapies, seems to have significantly improved the outlook for people with more severe AS.

Unlike the NSAIDs the biological therapies can slow down the progression of the disease.

Normally the response to Enbrel (Eternacept) or Adalimumab treatment is assessed at 12 week intervals and continued only if there is evidence of improvement. 

However, you are right to consider the side-effects . Serious side effects such as serious skin reactions, cancers, leukemia, lymphoma and infections have been reported in people using it. Not everyone will experience all the listed side-effects. Since this is a complicated issue that will require your specialist’s input.

You, together with your specialist, will need to weigh up the benefits against your own individual risk of developing the side effects including cancer.

We suggest that you have a chat with your specialist explaining your concerns and discussing factors such as 

How severe is your AS condition. 

Your family history

If you do start using Enbrel how will you be monitored for side-effects.

If you would like to have further information including results of clinical trials before you speak to your specialist or even afterwards  please feel free to call here at Health at Hand on 0800 003 004.

You may also wish to call the National Ankylosing Spondilitis Society . We've included their contact details below.

The National Ankylosing Spondylitis Society

Unit 0.2, One Victoria Villas, Richmond, Surrey, TW9 2GW

Helpline: 020 8948 9117

Web: www.nass.co.uk

Provides information and support. For example, the society has a network of over 90 centres in the UK that provide weekly exercise sessions supervised by a physiotherapist. They also publish and sell a home exercise video.

Answered by Health at Hand nurses

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