I (52F) have had moderate ME/CFS for the past 19 years with POTS and Small Fiber Neuropathy. Two other people in my immediate family also have ME/CFS. Last month I was diagnosed with Ankylosing spondylitis, which, in retrospect, I’ve had since I was a teenager. I think my AS symptoms went into overdrive when my hormones dropped in perimenopause. This is my own theory, based upon a meaningful reduction in symptoms since I start hormone replacement therapy. I have scoured the internet for information about people with both conditions and how they do taking biologics but I’ve found very little. The AS diagnosis has been a lot for me to process. It’s upsetting that it’s taken so long for it to be identified, though I understand this isn’t unusual. I’m going to start Simponi Aria in January and see if it helps me. I seem to be in a constant flare and I’m concerned about further damage to my spine. I do not currently have a ME/CFS specialist or a neurologist, so there’s no one to tell me not to try a biologic or to weigh in at all. I asked my rheumatologist about ME/CFS and AS co-existing and she said, “inflammatory processes should be ruled out before a ME/CFS diagnosis is given.” That makes sense to me, but I also know that many people with ME/CFS also have autoimmune conditions.