New treatments transform lives for patients with ankylosing spondylitis
The prediction was crushing. “You’re going to need crutches to get around,” Ryan Timlin recalls a healthcare professional telling him.
Timlin was only 21. He had already seen at least 10 specialists, and still he had no answers or solutions for his excruciating neck and back pain. “They all led to dead ends,” Timlin says.
Once a runner, Timlin was determined to get his health back on track. He sought the expertise of John D. Reveille, MD, director of the Division of Rheumatology and Clinical Immunogenetics at The University of Texas Medical School at Houston, who helped put him on an open road to a better quality of life.
Reveille diagnosed Timlin with ankylosing spondylitis (AS), a form of arthritis that attacks the spine and also can target other joints and organs in the body. The Centers for Disease Control and Prevention for the National Arthritis Data Workgroup estimates that AS and its related diseases affect as many as 2.4 million people in the United States. The inflammatory disease usually strikes when patients are in their teens, 20s or 30s.
Once considered an insidious, debilitating disease, new treatment options and genetic research are helping to change the prognosis for patients like Timlin.
“We’ve made some significant discoveries that are dramatically impacting the quality of life for our patients,” says Reveille, who sees patients at UT Physicians Rheumatology Clinic and Memorial Hermann-Texas Medical Center. “While there is still no cure, early diagnosis and proper medical management can greatly minimize back pain and stiffness and help reduce the risk of disability and deformity.”
Recent studies, including those done at the UT Medical School and Memorial Hermann-TMC, show that biologic medications, also known as Tumor-Necrosis-Factor alpha (TNF-a) blockers, can potentially slow or halt the disease progression in some people, Reveille says.
A curvature of the spine that causes the head to hang lower than the shoulders has been a classic characteristic of the disease. Now, with early treatment, the disease may never advance to the point where it forces patients into a stooped position.
Timlin, who is enrolled in a clinical trial to test the effectiveness of Golimumab, described his participation in the drug study as “transformational.” Prior to his diagnosis, he dropped out of school because it was too painful for him to walk to class. “Now my pain is greatly reduced and I have a greater range of motion,” Timlin says. He now is back in school training to be a computer network specialist. And he does it all without the aid of crutches.
TNF-a blockers are only one group of treatment options. There also are non-steroidal anti-inflammatory drugs (NSAIDs) and anti-rheumatic medications. Exercise, Reveille says, is also an integral part of any AS management program. Regular daily exercises can help create better posture and flexibility while lessening pain.
In addition to the growing number of treatment options, Reveille says, there also have been key genetic discoveries. Reveille is part of the Triple “A” Spondylitis Consortium Genetic Study (TASC) that recently discovered two genes –ARTS1 and IL23R – that cause AS. “These genes, which we described two years ago, have been subsequently confirmed all over the world and additional new AS genes will be announced soon,” Reveille says.
“The scientific community is close to fully understanding ankylosing spondylitis,” says Reveille, the George S. Bruce, Jr. Professor in Arthritis and Other Rheumatic Diseases and Linda and Ronny Finger Foundation Distinguished Chair in Neuroimmunologic Disorders. “This could lead to new therapies for the arthritic condition and help us identify patients who are at the greatest risk for developing AS.”
Timlin says the advances in AS research and treatment are encouraging. “For people who are suffering but haven’t yet been diagnosed, my best is advice is: Don’t give up. Keep searching until you find the answer. Once you are diagnosed, find a medication that works for you. And don’t forget to stretch. That’s important. The medication and the exercises won’t heal AS, but they will stop the progression.”