Anti-TNF-alpha therapy in ankylosing spondylitis

Ankylosing spondylitis (AS) is a frequent disease leading to functional impairment and socioeconomic burden. Anti-TNF-alpha therapy has brought new perspectives in this condition. Two agents are currently used in the treatment of AS and spondyloarthropathies - infliximab (a chimeric monoclonal antibody) and etanercept (a soluble p75 TNF-receptor). Open-label studies have shown the feasibility and efficacy of these drugs. Controlled studies have confirmed the latter, at least in the short-term (1 year). Improvement in several clinical parameters, function, quality of life, biological parameters and magnetic resonance imaging acute inflammation, have been observed. Due to these favourable results, anti-TNF have been approved for the treatment of AS. However, there are some safety concerns, essentially involving infection. Consensus guidelines for the use of anti-TNF in AS are available and assessment is based on validated tools. However, some questions still remain unanswered, such as the long-term efficacy and safety of anti-TNF, the possibility of structural benefit and the cost-effectiveness. Despite these concerns, Anti-TNF represents a major therapeutic advancement in the treatment of AS.