Biologics and arthritis

Hi, folks. I hope you’re all doing well. I haven’t been on the forum much the past few months as the whole family started a new school year (teachers and learners!) and it’s been very busy.

The good news is that six months in, I’m still having good response to Entyvio. So so grateful for a positive first biologic experience.

The conundrum is that I had a first rheumatology appointment this week to discuss incidental CT findings of mild arthritic change to my SI joints. I have a history of neck pain and upper back pain and very damaged TMJ joints, but back and leg pain only really since last fall.

The rheumatologist intern jumped right away to suggesting we change my biologic (to a Humira biosimilar or another TNF inhibitor). She thinks I have spinal arthritis secondary to my UC. I pushed back a little and asked for more investigation, so I’m waiting on an MRI and X-rays. She also ordered lots of blood tests.

To be honest, I have a fair bit of pain that waxes and wanes . But I also feel like lots of people I know have back pain?

Here’s my main concern: we don’t know if another biologic would work as well for the UC, and so it feels wrong to jump ship from Evtyvio while I have good response. There are only so many biologics, and I don’t want to burn through them all or take a gamble on one that may not actually help both conditions.

I asked about adding methotrexate or something, but she said it’s only useful for peripheral arthritis, not spinal/hip.

Does anyone have experience with a similar conundrum? What advice have your doctors given? Our health system in my part of Canada doesn’t really allow for second opinions, and my gastro doesn’t actually specialize in UC, so I’m keen to gather more wisdom before we start to have our conversations.

Obviously a lot will be determined by the tests, too, but I’ll be surprised if they don’t find arthritic inflammation, so I’d like to go in prepared.

Thank you!

Yes. See my posts on the main UC page on this issue.

Ultimately it is an inflammation problem. I too am on Entyvio and seem to be in bowel remission but have been diagnosed with an inflammatory arthritis. I would take the bowel issues any day over the joint issues... absolutely without hesitation. You cannot hang around waiting it out if you do have joint damage....a mucus membrane like the intestine can heal much more efficiently than a joint. I am actively campaigning with my GI to take me off Entyvio and replace it with an anti TNF or another all purpose biologic. He wants to try Methotrxate first but I would prefer a more aggressive med to treat the joints. Evtyvio has a low chance pf producing antibodies and is much more amenable to being re-started later.

If your joint issues are inflammatory then this is your main problem right now and you bowel is secondary. You need to get the joints under control immediately and then see what how the bowel fits in with such.

Also regarding methotrexate, the flavonoid quercetin may be an alternative. It has shown efficacy in a clinical trial for rheumatoid arthritis.
https://www.tandfonline.com/doi/abs/10.1080/07315724.2016.1140093
and in an animal model of the condition was shown to be more effective than methotrexate or a combination of the two.
https://www.sciencedirect.com/science/article/abs/pii/s0753332217306121
"In conclusion, this study determined that quercetin, which was non-toxic, produced better results than methotrexate for the protection of joints from arthritic inflammation in mice. Quercetin may be an alternative treatment for RA because it modulates the main pathogenic pathways of RA."

Quercetin acts on elements of inflammatory pathways (TNF/NF-kB/il17 etc) common to many issues including SpA and RA (and UC). It is not an answer in itself though, I was just pointing out that there is evidence that it may be a much safer alternative to methotrexate. What a good naturopath will do is reduce/eliminate anything that feeds the inflammatory pathway and add interventions that downregulate it at various points. Quercetin is just one of these.

Vagal nerve stimulation is something I am looking at at the moment for UC as it interferes with inflammatory signalling. There is some evidence for inflammatory arthritis also and with the use of a small TENS type device should be practical.

https://www.frontiersin.org/articles/10.3389/fnins.2021.650971/full
https://www.hindawi.com/journals/mi/2021/9933532/

Post Edited (waxmoth) : 10/11/2022 4:19:21 AM (GMT-7)

If it’s arthritis you’re looking to minimize and if my experience has any relevancy, Humira’s not your gig.

Seven cortisone shots in three different joints so far this year. Never had arthritis in my life until now.

There’s a myriad of other side effects as well. But I’m by Humira like you are by Entyvio. While I could do without it’s side effects, Humira’s keeping my UC gut issues pretty much in check.

Take care. 🌈

Thanks for the feedback, folks. It’s a two month wait for MRI, bit I’m hoping the MRI and X-rays are illuminating, along with blood work. Trying to keep a good attitude: it feels a bit like I can’t catch a break, you know?

The damage already done to my jaw joints is severe, but the rheumatologist thinks it’s totally separate, a structural problem (physical therapist still suspects the jaw is from Ankylosing Spondylitis too). The mystery is why more issues didn’t present a little sooner, but maybe I’ve just been ignoring a lot of pain, as one does.

I’m grateful to have a community here of folks who know what it’s like to have a few mysterious piled-on health problems. A lot of friends and family think so much can’t possibly be wrong with one body, and they’re tired of hearing about it, but it’s all a lot to process.

Grateful for you all.