Management and treatment of ankylosing spondylitis

Purpose of review Our purpose is to review the developments in the treatment of ankylosing spondylitis in 2004. Recent findings Tumor necrosis factor blockers have been shown to have rapid and persistent efficacy with limited additional toxicity up to 4 years with continuing therapy, but cessation of therapy results in relapse in most patients. Therapy is cost-effective. There are some differences between the different tumor necrosis factor blockers currently available. Other biologic therapies are not as promising. Algorithms have been developed to aid in early diagnosis. This may be relevant for future therapeutic strategies. Summary Tumor necrosis factor blockers are effective and safe in active spinal disease, but simple measures such as exercise and nonsteroidal anti-inflammatory drug therapy are still considered the basis of standard therapy. Early disease diagnosis is becoming easier, and is likely to be important for optimal therapeutic responses. Future research will include the effect of tumor necrosis factor blockade on structural disease progression.