Editorial review: how early should ankylosing spondylitis be treated with a tumor necrosis factor-blocker?

Abstract

PURPOSE OF REVIEW:

Therapy of ankylosing spondylitis with tumor necrosis factor (TNF)-blockers is very effective in about 50% of patients. The focus of this review is to discuss how early in the course of the disease patients with axial spondyloarthritis should be treated with TNF-blockers.

RECENT FINDINGS:

During the last 10 years TNF-blockers were investigated in established ankylosing spondylitis. More recently clinical trials focused on early treatment including patients with axial nonradiographic spondyloarthritis. It could be shown that TNF-blockers are at least as effective in patients with axial nonradiographic spondyloarthritis when compared with established ankylosing spondylitis and that TNF-blockers are even more effective when used earlier in the course of the disease and in younger age. Some data even indicate that drug-free remission might be achieved if patients are treated earlier. Active inflammation as seen by MRI can effectively be suppressed during therapy with TNF-blockers. It has been hypothesized that early anti-inflammatory treatment is the best way to prevent ankylosis, which has to be proven in future studies.

SUMMARY:

TNF-blockers can achieve a higher clinical response if ankylosing spondylitis patients and patients with nonradiographic axial spondyloarthritis are treated earlier. Whether very early treatment affects ankylosis has to be further investigated.

• Authors: Hildrun Haibel, Joachim Sieper
• Journal: Current opinion in rheumatology (Curr Opin Rheumatol) Vol. 22 Issue 4 Pg. 388-92 (Jul 2010) ISSN: 1531-6963 [Electronic] United States
• PMID: 20473176 (Publication Type: Editorial, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Antibodies, Monoclonal
• Antirheumatic Agents
• Receptors, Tumor Necrosis Factor
• Tumor Necrosis Factor-alpha

Topics

• Antibodies, Monoclonal (therapeutic use)
• Antirheumatic Agents (therapeutic use)
• Humans
• Receptors, Tumor Necrosis Factor (antagonists & inhibitors)
• Spondylitis, Ankylosing (therapy)
• Tumor Necrosis Factor-alpha (therapeutic use)