caret icon Back to all discussions

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

Hello everyone. I just met with my new rheumatologist for the first time today after my family physician diagnosed me with Ankylosing Spondylitis about 2 months ago. I only met with him for about 15 minutes and was a little surprised when he quickly brought up starting me on Enbrel (after also mentioning that he hasn’t reviewed my X-rays). Now, I wouldn’t say I live with a 10/10 for pain everyday (not that I think I should have to) but I just don’t know if starting a biologic right off the bat is something I want to do, but this is new territory for me and I’m not sure how to navigate any of this. There are a fair number of days that I feel pretty good. I’m also absolutely terrified of having to give myself a shot every week- so there’s that. So now my question is, when did YOU know it was right for you to start a biologic? Was there a moment in your disease where you were like “this is the last straw and I want these expensive, lifelong meds that might not be a good fit for me”. Thanks for listening and for any wisdom from the been there done that crew

  1. 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:'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!

    1. 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.

      1. 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.

        1. Hello, I'm a relative newbie to AS, having been diagnosed 7 mos ago at the age of 64. in restrospect I had some of the symptoms in my teens and early 20's but not bad enough to send me to a Dr. I too was hesitant to start biologics feeling that I was not bad enough to warrant that therapy. However I have spoken to 3 AS patients who were on Simponi and all three were very grateful for the results they have had. Their only regret was not starting therapy sooner. My goal is to reduce pain, flair ups and maintain a quality of life... with that criteria (and I don't mean to over simplify) why wait? I am fortunate to have a great Rheumatologist who believes in an aggressive approach, and she explained the therapy risks and gains. I have good insurance leaving my only a $45 copay for the infusion. I'm an optimist by nature and look forward to being in much less pain and enjoying my life as I head into retirement. Hope this helps.

          1. ,
            Thanks so much for chiming in and sharing your experience.
            Please keep us updated on how your treatment is going.
            All my best, Doreen (Team Member)

        Please read our rules before posting.