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Taipei City Hospital

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The Troubles of Ankylosing Spondylitis

       A 42 years old male painter has been diagnosed with ankylosing spondylitis (AS) for seven years. The main clinical symptoms are stiffness of the major joints in the morning, such as the shoulder and hip joints, and severe impairment of forward and side leaning movement of the spine. The patient is worried that the condition will severely impact his financial stability, as he is the sole source of income for the household, but due to the severity of the muscle and joint pain, he was not able to work normally, and feared that he may be on the way to permanent disability. The patient is currently being treated with anti-inflammatory drugs, analgesics and physiotherapy.

       According to Dr. Tong Hua Liang, Director of the Division of Allergy, Immunology and Rheumatology at the Renai Branch of the Taipei City Hospital, the latest type of therapeutic drugs for treating AS are biopharmaceutics (or biological agents), which will reduce the progression of AS and allow patients to regain normal daily functions. Dr. Liang stated that anti-tumor necrosis factor agents (Anti-TNF) can modulate immune effects, and the currently available anti-TNF products on the market include Adalimumab (Humira), Etanercept (Enbrel) and Golimumab (Simponi). These are anti-rheumatic disease modification drugs in biopharmaceutical form, which modulate and inhibit inflammation. The genetically recombinant human immunoglobulins block excessive TNF-α production that causes swelling and inflammation, similar to the naturally occurring antibodies in the body, and help to counter the disease symptoms. While biopharmaceutics can effectively alleviate the symptoms caused by AS, they are regulated by the National Health Insurance payment plans, and can only be used if the application fulfills the NHI payment criteria.

       Aside from Anti-TNF products, there are also two biopharmaceutics with different action mechanisms: Ustekinumab (Stelara) and Secukinumab (Cosentyx), which can all effectively control inflammation, joint adhesion and stiffness in patients with AS, allowing them to function normally once again.