Can Anti-TNF Therapy Play a Role in the Treatment of Ankylosing Spondylitis?

Arthur Kavanaugh, MD


January 17, 2006


Can anti-tumor necrosis factor (TNF) therapy play a role in the treatment (early- or late-stage spinal involvement) of ankylosing spondylitis (AS)?

Response From the Expert


Arthur Kavanaugh, MD 
University of California at San Diego, Division of Rheumatology, Allergy, and Immunology, La Jolla, California.


One of the most exciting therapeutic advances in recent years in rheumatology has been the introduction of TNF inhibitors for the treatment of signs and symptoms of AS.[1,2] Similar to the results seen in rheumatoid arthritis and psoriatic arthritis, TNF inhibitor therapy substantially improves the signs and symptoms of disease for AS patients. To date, impressive clinical results have been noted in rigorous trials of all 3 currently available TNF inhibitors: etanercept, infliximab, and adalimumab. This is of particular interest for AS patients, because traditional disease-modifying antirheumatic drugs (DMARDs) have been shown to be largely ineffective in treating axial symptoms of patients with AS. A key question that remains is whether TNF inhibitor therapy may affect the radiographic progression of AS. Because disease progression varies among affected individuals, and because it tends to progress over the course of several years, large long-term studies are necessary to fully define the effect of such treatment on radiographic progression. However, in studies assessing the more sensitive technique of magnetic resonance imaging, it does appear that TNF inhibitors can have a positive effect. Further results are anxiously awaited.


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