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Treatment update on spondyloarthropathy
Allen Anandarajah1, Christopher T Ritchlin
1Allergy, Immunology & Rheumatology Unit, University of Rochester Medical Center, Rochester, New York, USA.
Current Opinion in Rheumatology
|April 20, 2005
Summary
Tumor necrosis factor antagonists are effective and safe for ankylosing spondylitis and psoriatic arthritis. New treatments are being studied for patients unresponsive to these therapies, including novel agents and antibiotics.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Ankylosing spondylitis and psoriatic arthritis treatments have advanced with biologic therapies.
- Concerns about cost and long-term safety of tumor necrosis factor (TNF) antagonists prompt exploration of alternatives.
- Recent studies highlight higher morbidity in ankylosing spondylitis and psoriatic arthritis than previously understood.
Purpose of the Study:
- To summarize recent treatment advances in spondylarthropathy.
- To discuss potential future therapies for these conditions.
Main Methods:
- Review of phase III clinical trials for TNF antagonists (etanercept, infliximab, adalimumab).
- Evaluation of studies on methotrexate and antibiotic combinations for spondylarthropathies.
- Identification of emerging therapeutic targets.
Main Results:
- TNF antagonists demonstrated safety and efficacy in phase III trials for psoriatic arthritis and ankylosing spondylitis.
- Etanercept showed potential in slowing radiographic progression in psoriatic arthritis.
- Methotrexate's efficacy in axial ankylosing spondylitis remains debated; antibiotic combinations may benefit reactive arthritis.
Conclusions:
- TNF antagonists are confirmed as effective and safe for ankylosing spondylitis and psoriatic arthritis.
- Alternative treatment options are under investigation for non-responders.
- Future research will clarify the roles of DMARDs, novel agents, and antibiotics in spondylarthropathy management.