Case notes

TNF inhibitor in AS

Neuro Medical Clinic, Mall Road, Saddar, Rawalpindi · Dr. Umar Zafar Ali, Neurologist & Medical Specialist

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.

Doing it properly

Little and often beats one long session. Keep to the stated frequency for at least two weeks before judging whether it is helping, and stop any movement that causes sharp pain rather than working through it.

Come in if

Symptoms are worsening, waking you at night, spreading to a new limb, or unchanged after four weeks. Walk in during clinic hours — Monday to Saturday, 11:00 am to 06:00 pm — and bring this guide and any reports with you.

A question about your own case is better answered by the doctor than by a guide. Message the clinic with your name and file number.

General education, not a prescription. Seek urgent care for sudden weakness, slurred speech, a first-ever fit, a face that has drooped, or the worst headache of your life.