Clinical and laboratory improvement in ankylosing spondylitis after treatment with etanercept: a case report

A patient with ankylosing spondylitis involving the back, feet, ankles, knees, wrists, hands, and elbows exhibited intolerance or inadequate response to multiple prior therapies. Because of the potential role of tumor necrosis factor in the pathogenesis of AS, the tumor necrosis factor antagonist etanercept (Enbrel) 25 mg was given s.c. twice weekly. Beginning 2 weeks after the initiation of etanercept, the patient noted symptomatic improvement in axial and peripheral joints. The patient experienced resolution of morning stiffness and near complete resolution of fatigue. Marked improvement in hemoglobin and erythrocyte sedimentation rate was also seen, although knee joint fluid leukocytes did not change appreciably. This response is encouraging, especially because both axial symptoms and peripheral disease responded to treatment, in contrast to what has been previously reported for sulfasalazine. Further study of etanercept in ankylosing spondylitis is warranted.