Disease controlling antirheumatic therapy in spondyloarthropathy

The management of spondyloarthropathy (SpA) is based more on clinical presentation (axial vs peripheral involvement) than on actual disease diagnosis. Treatment is aimed at controlling inflammation, ankylosis, and abnormal posture. Nonsteroidal antiinflammatory agents are the cornerstone of treatment for patients with axial involvement. If these do not work, disease controlling antirheumatic therapy is usually prescribed. Several drugs, particularly sulfasalazine, produce clinically significant improvement in patients with articular peripheral involvement. In contrast, the therapeutic options for patients with refractory axial involvement are very limited. For this group, "potential" (pamidronate, thalidomide) or "specific" (infliximab) tumor necrosis factor blockers are of potential interest and deserve further evaluation. Therapeutic efficacy is monitored chiefly according to clinical variables, although biochemical markers such as C reactive protein are also helpful.