Treatment of ankylosing spondylitis and other spondyloarthritides

Purpose of review The management of ankylosing spondylitis and other spondyloarthriticles (SpAs) such as psoriatic arthritis (PsA) is becoming more and more complex due to major advances, especially in the pharmacological therapy of these diseases. Biologics such as the antitumour necrosis factor agents have the potential to improve almost all outcome parameters usually assessed, The purpose of this review was to collect all available information related to the treatment of ankylosing spondylitis published in the year 2008. This was achieved by a systematic literature search in PubMed. Recent findings There is increasing knowledge about the short-term and long-term efficacy of antitumour necrosis factor agents. As it stands now, radiographic progression of ankylosing spondylitis patients is not decelerated, in contrast to PsA. One major difference between the two SpAs is that ankylosing spondylitis is more an osteoproliferative disease, whereas PsA is more osteoclestructive (though it certainly has both elements). Methotrexate offers no additional benefit for the axial symptoms in ankylosing spondylitis. Other biologics such as efalizumab, which is used to treat psoriasis, seems to increase the frequency of arthritis. A whole array of potential side effects has been reported. Cardiovascular comorbidity seems to be rather important for SpA patients. Summary In this review, we especially cover not only the following themes of new clinical studies, efficacy regarding signs and symptoms, function and quality of life but also structural damage and the link between inflammation and new bone formation. The pharmacokinetics of infliximab including the formation of antibodies and the overall and long-term safety of anti-tumour necrosis factor agents is covered.