Developments in therapies for spondyloarthritis.

Area of Science:

• Rheumatology
• Immunology
• Clinical Trials

Background:

• First-line therapy for spondyloarthritis (SpA) remains NSAIDs and physical therapy, despite new classification criteria.
• Anti-TNF agents are used for NSAID-refractory disease, but trials were limited to patients with established active disease.
• New classification criteria now allow inclusion of patients with non-radiographic axial SpA (nr-axSpA) in treatment trials.

Purpose of the Study:

• To evaluate the efficacy of TNF blockers in patients with axSpA, including those with nr-axSpA.
• To identify predictors of response to TNF-blocking agents in axSpA.
• To assess the role of NSAIDs and TNF blockers in preventing new bone formation in axSpA.

Main Methods:

• Inclusion of patients with nr-axSpA and radiographic axial SpA (ankylosing spondylitis) in therapy trials.
• Evaluation of TNF blockers' efficacy in both radiographic and non-radiographic axSpA populations.
• Analysis of baseline characteristics, including symptom duration and C-reactive protein levels, as predictors of treatment response.

Main Results:

• TNF blockers appear to be at least as effective in patients with nr-axSpA as in those with established ankylosing spondylitis.
• Short symptom duration and elevated C-reactive protein at baseline are the strongest predictors of a favorable response to TNF blockers.
• NSAIDs are currently considered more effective than TNF blockers in preventing new bone formation.

Conclusions:

• New classification criteria facilitate more systematic treatment trials for axSpA, including the nr-axSpA subgroup.
• TNF blockers are effective in both radiographic and non-radiographic axial SpA, with specific predictors for treatment success.
• The long-term impact of early anti-TNF therapy on preventing ossification requires further investigation.