Question
I am 35 years old now and was diagnosed with Reiter’s syndrome in 2003, hospiatlized with severe right sacroiliac pain. Presently I am on NSAIDs and short courses of prednisone to treat the flares. These worked until recently when my right sacroiliac joint and the surronding areas are stiff and hurt a lot. I want to go on long term treatment with one of the DMARDs, but am hesitant due to the side effects these might produce. How safe are these DMARDs in treating the disease and duration of use? Will I be able to go on them for 15 or 20 years without critically damaging my system? Are biologics better? I have read that biologocs can cause lymphoma and trigger other serious infections? Your response is greatly appreciated.
Answer
Make sure you look on this website for addtiional information. In terms of effectiveness, traditional DMARDs such as methotrexate help the peripheral joints but likely do not help the symptoms of the spine such as sacroilitis. Biologic agents the TNF inhibitors are the only medications effective for the spine beyond NSAIDs. Long term trials and registries are still ongoing to answer the questions about safety of the biologic agents. However, the information to date looks very promising that there will not be any significant long term side effects. Etanercept (Enbrel) has reported 9 year long term data showing safety and effectiveness. There is a slight increased risk of serious infections with TNF inhibitors. Most studies have not shown an increase in lymphoma.
