Current concepts in the therapy of the spondyloarthritides
Abstract
Recent success in the treatment of patients with the more severe forms of spondyloarthritides (SpA) has dramatically changed old paradigms. There is evidence that anti-tumor necrosis factor (TNF)-alpha therapy is highly effective in SpA, especially in ankylosing spondylitis (AS) and psoriatic arthritis. Based on recent data on more than 1000 patients with AS and psoriatic arthritis, this treatment seems to be even more effective than in rheumatoid arthritis (RA). The currently available anti-TNFalpha agents, infliximab, etanercept, and adalimumab, are approved for the treatment of RA in the US and in Europe. TNFalpha blockers may even be considered as a first-line treatment in patients with active AS whose condition is not sufficiently controlled with NSAIDs, as in the case of axial disease. There is preliminary evidence that both agents also work in other SpA, such as undifferentiated SpA. There is hope that ankylosis may be preventable, but it remains to be shown whether patients benefit from long-term anti-TNFalpha therapy and whether radiologic progression and ankylosis can be stopped. Furthermore, it seems that anti-TNFalpha therapy can also improve clinical manifestations of other inflammatory spinal disorders, such as sc...Continue Reading
References
Demyelination occurring during anti-tumor necrosis factor alpha therapy for inflammatory arthritides
Efficacy of infliximab in refractory ankylosing spondylitis: results of a six-month open-label study
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