When did you know it was time to start a biologic?

I think I have had AS since forever. Always bone pain while growing up. I was diagnosed in 2017. I passed on the gene to one of my kids and a grandchild. I also have MS. I had recently stopped taking the recommended MS drugs because of side effects, so I strongly resisted going on any biologic. I had been having neck pain for years, and started having pain that prevented sleep because of leg and back spasams. I was sent to a pain doctor, which really helped. However I kept having more and different pain almost constantly. Unfortunately it was difficult to get into a rheumatologist. When I did get iin, I found that my thoracic spine was fused as was most of my neck. I felt really stupid for not starting the biologic (Cosentyx) sooner. Because I knew that the biologic would reduce inflammation, which could reduce pain, I prayede it would hopefully stop progression. When I stopped the MS drug, new information about diet and MS came out. I started the AIP paleo diet. I also dedicated myself to exercise. I have had no change in the MS for years. I hope the same is true for the AS.

Hi areser. I agree with the others: you need a full workup of blood tests and x-rays before any medication should be recommended or taken.

(As I was explaining to my spouse last night,) AS meds seem to have a few levels, based on what works for you: 1 = NSAID, 2 = DMARDs, 3 = biologics (please everyone forgive me if I'm way off base here... I've researched this to death online and think I have a basic understanding of my options).

You might find this video helpful:
https://www.webmd.com/rheumatoid-arthritis/video/video-dmard-vs-biologic#:~:text=That's%20mostly%20due%20to%20two,components%20of%20your%20immune%20system.


As for when you'll "know"... There may come a time when your physical complaints are not being helped by NSAIDs.

Like you, a rheumatologist recommended I begin biologics right away at my very first appointment... And this was at the beginning of the pandemic and my appointment was done via a video call! Crazy. I felt exactly as you did, and decided I'd wait; I honestly didn't feel "ready" to be putting a new drug into my body and didn't really feel that I was suffering enough to justify any potential side effects. Since then, I'm encouraged to read here how many people are grateful for these drugs.

Almost three years later, I'm starting to feel quite fatigued now, and would really like to try to do something about that. I've had to start being very intentional about how often I use our stairs, am mindful of how many physical tasks/chores I can handle in a given day, and I've started to go to bed earlier. All of this is helping my energy reserves for the next day, but I'd still like to have more energy/feel more like my old self. So I think I may be ready to possibly try a prescription. I got all the tests done a few weeks ago by my new rheumatologist (wow they took so much blood and I've never had that many Xrays in one day!). My follow-up appointment happens right after the holidays; her forecast is to recommend TNFi "if evidence of axial involvement," or Methotrexate "if no clearly axial involvement."

Question for readers: Have any of the AS medications helped improve your energy level? That is something I'd love to know, and would be my primary motivation for trying something beyond NSAIDs.


Thanks, happy holidays, and good luck!

Just some food for thought that I didn’t realize until Keegan’s specialist brought it up. Regardless of whatever medication you take, the doctor told us that the point of treating AS is both reactive and proactive. Reactive in that you want to manage things like pain and brain fog. Proactive in that some treatments are done in the hope of putting the AS into remission so that there isn’t disease progression.


For Keegan, his best chance at remission is a biologic. I wonder if that’s why your specialist recommended it upfront.

I had the same fears when I was first diagnosed with AS and my doctor wanted to start me on Humira right away. After talking through the options I decided to try NSAIDs first. I was on meloxicam for about two years before starting Humira.


For me, the “final straw” came when I had so much pain that I had to roll out of bed on to the floor to get up in the morning. It wasn’t a sudden spike in my symptoms, the meloxicam had been gradually less effective, and I think my very active job didn’t help. Looking back I wish I had made the switch to Humira earlier.


Ultimately it’s your treatment and your decision. There’s nothing wrong with weighing your options. The most important thing is to listen to your body and don’t let your symptoms get to the point that they are unmanageable.