More ankylosing spondylitis patients switching to biologic treatments
- POSTED: 07 Oct 2013 23:44
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The Singapore General Hospital sees some 200 patients suffering from ankylosing spondylitis and a growing number of them are switching to biologic treatments which include an injection as opposed to oral medication.
SINGAPORE: About 10,000 patients in Singapore suffer from ankylosing spondylitis - an arthritic condition that affects the joints of the spine.
The condition affects mainly young people from the age of 15 to 35 and men are more prone to it.
The Singapore General Hospital (SGH) sees some 200 patients with this condition and a growing number of them are switching to biologic treatments which include an injection as opposed to oral medication.
The condition usually starts off with stiffness and pain in the lower body. Ankylosing Spondylitis patients may also have eye inflammation and bowel diseases.
While the exact cause of the condition is unknown, it is linked to genetic factors associated with the immune system. There is about a 15 per cent chance for a child to develop ankylosing spondylitis when a parent has the condition.
Currently, the majority of patients at SGH are on long term non-steroidal anti-inflammatory drugs.
There are about more than 10 kinds of these drugs in the market which include diclofenac and mefenamic acid.
For those who don't respond to oral medication, the various forms of biologic treatments include adalimumab, etanercept, infliximab and golimumab.
A growing number of patients are switching to biologic therapy - a form of self-injection, similar to the insulin injections done by diabetic patients.
Since the centre opened in 2011, less than five of them were under this therapy. To date, more than 20 patients have opted for this treatment option.
Doctors and nurses also spend more time with the patients and explain to them the benefits and the mode of delivery of medication. The nurses will also teach the patients to self-inject and they also monitor the method of injection to ensure the patients are competent to do the injection.
Of the 200 patients with this condition at SGH, almost all responded to this form of treatment.
Fifty per cent were in complete remission while 40 per cent had partial remission. The remaining 10 per cent had to switch to other forms of biologic treatments.
This is compared to 70 per cent of patients who responded to oral medication.
However, oral mediation has its side effects.
Dr Lui Nai Lee, a consultant at SGH's rheumatology and immunology department, explained: "This medication can potentially cause a flare up of tuberculosis (TB). Therefore, we usually screen the patient of past history of TB before we initiate this therapy for our patients. We also need to caution our patients that when they are on this medication, there's an increased risk of you catching an infection.
"Therefore, if you have any signs and symptoms of an infection for example, we usually would discourage you from injecting for that week."
As for the cost of treatment, biologic treatments can set a patient back about S$15,000 to S$20,000 a year.
This is far steeper than the cost of oral medication which ranges between S$300 and S$600 a year.
Patients with this condition are encouraged to do exercises which include stretching because it helps to reduce the stiffness in the spine and the limbs. Swimming is also recommended for all forms of arthritis.
And for it to be effective, exercises have to be done regularly and on a long term basis.