Managing Treatment

Talk to your doctor

A good relationship with your rheumatologist is an important part of treating ankylosing spondylitis (AS). One way to build that relationship is to help your rheumatologist understand your symptoms and how AS affects your daily life. When your doctor knows about your symptoms, he or she can decide what treatment is best for you.

By being open and honest with your rheumatologist, you give yourself the best chance of benefiting from your treatment. For example, tell your doctor about your pain, stiffness, and fatigue levels. Mention the treatments you have tried, how long you've taken them, and the results you've had. Writing out your questions in advance will help you have a more focused conversation.

To help you get the most from your appointment, we've created an Ankylosing Spondylitis Discussion Guide. Simply download and print the guide, answer the questions, and bring it to your next appointment. Answering these questions will help you discuss your symptoms with your doctor. Together, you and your doctor can then decide if treatment with REMICADE® may be right for you.

Discussion topics

Bring your completed Ankylosing Spondylitis Discussion Guide and make a list of topics you'd like to discuss with your rheumatologist, including:

  • Your symptoms
  • Medications you take
  • Your allergies (if any)
  • Your medical history, including procedures and previous illnesses
  • Previous AS treatments (if any) and the results you had with them

Be completely open about the symptoms that bother you:

  • Share details about your pain, stiffness, and fatigue levels
  • Tell your rheumatologist about any side effects you experience, including stomach problems or skin rashes
  • Talk to your rheumatologist about how AS has affected you emotionally

Questions to ask your rheumatologist

You may want to ask your doctor the following questions during your next visit:

  • Are further tests required to confirm my diagnosis?
  • What is happening to my body as a result of AS?
  • Aside from my spine, are there other areas of my body that might become involved?
  • Should I expect any complications from AS? If so, what might happen?
  • How are my AS symptoms likely to change in the future?
  • What are my treatment options for AS?
  • What is the purpose of the treatment you suggest?
  • How and when will this treatment make me feel better?
  • What are the benefits and potential side effects of this treatment?
  • What should I do if I experience side effects?
  • How and when should I exercise?
  • What activities should I modify or avoid?
  • What lifestyle changes should I make?
  • Are there any self-help devices that can help me perform daily tasks more comfortably?
  • Should I see other healthcare professionals, including a physical therapist?
  • When should I come back for a follow-up visit?

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Only your doctor can recommend a course of treatment after checking your health condition. REMICADE® (infliximab) can cause serious side effects such as lowering your ability to fight infections. Some patients, especially those 65 years and older, have had serious infections caused by viruses, fungi or bacteria that have spread throughout the body, including tuberculosis (TB) and histoplasmosis. Some of these infections have been fatal. Your doctor should monitor you closely for signs and symptoms of TB during treatment with REMICADE®.

Unusual cancers have been reported in children and teenage patients taking TNF-blocker medicines. Hepatosplenic T-cell lymphoma, a rare form of fatal lymphoma, has occurred mostly in teenage or young adult males with Crohn’s disease or ulcerative colitis who were taking REMICADE® and azathioprine or 6-mercaptopurine. For children and adults taking TNF blockers, including REMICADE®, the chances of getting lymphoma or other cancers may increase.

You should discuss any concerns about your health and medical care with your doctor.

What should I tell my doctor before I take REMICADE®?

You should let your doctor know if you have or ever had any of the following:

  • Tuberculosis (TB) or have been near someone who has TB. Your doctor will check you for TB with a skin test. If you have latent (inactive) TB, you will begin TB treatment before you start REMICADE®.
  • Lived in a region where certain fungal infections like histoplasmosis or coccidioidomycosis are common.
  • Infections that keep coming back, have diabetes or an immune system problem.
  • Any type of cancer or a risk factor for developing cancer, for example, chronic obstructive pulmonary disease (COPD) or had phototherapy for psoriasis.
  • Heart failure or any heart condition. Many people with heart failure should not take REMICADE®.
  • Hepatitis B virus (HBV) infection or think you may be a carrier of HBV. Your doctor will test you for HBV.
  • Nervous system disorders (like multiple sclerosis or Guillain-Barré syndrome).

Also tell your doctor if you:

  • Use the medicines Kineret (anakinra), Orencia (abatacept) or Actemra (tocilizumab) or other medicines called biologics used to treat the same problems as REMICADE®.
  • Are pregnant, plan to become pregnant, are breast-feeding, or have a baby and were using REMICADE® during your pregnancy. Tell your baby’s doctor about your REMICADE® use before the baby receives any vaccine because of an increased risk of infection for up to 6 months after your last dose of REMICADE® you received during your pregnancy.
  • Recently received or are scheduled to receive a vaccine. Adults and children taking REMICADE® should not receive live vaccines or treatment with a weakened bacteria (such as BCG for bladder cancer) while taking REMICADE®.

What should I watch for and talk to my doctor about before or while taking REMICADE®?

The following serious (sometimes fatal) side effects have been reported in people taking REMICADE®.

You should tell your doctor right away if you have any of the signs listed below:

  • Infections (like TB, blood infections, pneumonia)—fever, tiredness, cough, flu, or warm, red or painful skin or any open sores. REMICADE® can make you more likely to get an infection or make any infection that you have worse.
  • Lymphoma, or any other cancers in adults and children.
  • Skin cancer—any changes in or growths on your skin.
  • Heart failure—new or worsening symptoms, such as shortness of breath, swelling of your ankles or feet, or sudden weight gain.
  • Reactivation of HBV—feeling unwell, poor appetite, tiredness, fever, skin rash and/or joint pain.
  • Liver injury—jaundice (yellow skin and eyes), dark brown urine, right-sided abdominal pain, fever, or severe tiredness.
  • Blood disorders—fever that doesn’t go away, bruising, bleeding or severe paleness.
  • Nervous system disorders—numbness, weakness, tingling, changes in your vision or seizures.
  • Allergic reactions during or after the infusion—hives, difficulty breathing, chest pain, high or low blood pressure, swelling of face and hands, and fever or chills.
  • Lupus-like syndrome—chest discomfort or pain that does not go away, shortness of breath, joint pain, rash on the cheeks or arms that gets worse in the sun. The more common side effects with REMICADE® are respiratory infections (that may include sinus infections and sore throat), headache, rash, coughing and stomach pain.
  • Psoriasis—new or worsening psoriasis such as red scaly patches or raised bumps on the skin that are filled with pus.

Please read the accompanying Medication Guide for REMICADE® and talk with your doctor. You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.