A man with backache of inflammatory character, limited flexion and difficulty in daily job.
RA negative. HLA B27 positive.
Lumbar spine xray show syndesmophytes and early bamboo spine:
TNF inhibitors have shown efficacy in AS. Five drugs approved by FDA are: Adalimumab, Certolizumab, Infliximab, Etanercept, and Golimumab. All are available as injections and are costly.
An important drug not approved by FDA which is of low cost, easily available and can be taken orally is Thalidomide. Its a TNF inhibitor and except in pregnancy, can be safely used.
This patient was given thalidomide with remarkable improvement, asymptomatic and is working on his daily job.