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Developments in therapies for spondyloarthritis.
Nat Rev Rheumatol 2012; 8(5):280-7NR

Abstract

First-line therapy for spondyloarthritis (SpA) has not yet altered in the wake of new classification criteria; NSAIDs and physical therapy are recommended. Anti-TNF agents can be used when NSAIDs fail, but their efficacy has potentially been limited in previous trials by inclusion criteria requiring the presence of established, active disease. Now, not only patients with axial SpA (axSpA) with radiographic signs of sacroiliitis (that is, with ankylosing spondylitis), but also patients in whom structural damage is not-yet-visible radiographically (non-radiographic axSpA) can be included in trials of therapy for axSpA. TNF blockers, it seems already, are at least similarly effective in patients with non-radiographic axSpA as in those with established AS. Short symptom duration and a positive C-reactive protein test at baseline are currently the best predictors for a good response to TNF-blocking agents. Biologic agents besides anti-TNF therapies have so far failed in the treatment of axSpA. New bone formation seems currently to be best prevented by NSAIDs, not by TNF blockers. Whether earlier effective treatment of bony inflammation with anti-TNF therapy will be able to prevent ossification at a later stage has yet to be determined. New classification criteria for peripheral SpA will also allow treatment trials to be conducted more systematically than has previously been possible in this subgroup of patients.

Authors+Show Affiliations

Rheumatology, Department of Medicine, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. joachim.sieper@charite.de

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22487798

Citation

Sieper, Joachim. "Developments in Therapies for Spondyloarthritis." Nature Reviews. Rheumatology, vol. 8, no. 5, 2012, pp. 280-7.
Sieper J. Developments in therapies for spondyloarthritis. Nat Rev Rheumatol. 2012;8(5):280-7.
Sieper, J. (2012). Developments in therapies for spondyloarthritis. Nature Reviews. Rheumatology, 8(5), pp. 280-7. doi:10.1038/nrrheum.2012.40.
Sieper J. Developments in Therapies for Spondyloarthritis. Nat Rev Rheumatol. 2012 Apr 10;8(5):280-7. PubMed PMID: 22487798.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Developments in therapies for spondyloarthritis. A1 - Sieper,Joachim, Y1 - 2012/04/10/ PY - 2012/4/11/entrez PY - 2012/4/11/pubmed PY - 2012/9/5/medline SP - 280 EP - 7 JF - Nature reviews. Rheumatology JO - Nat Rev Rheumatol VL - 8 IS - 5 N2 - First-line therapy for spondyloarthritis (SpA) has not yet altered in the wake of new classification criteria; NSAIDs and physical therapy are recommended. Anti-TNF agents can be used when NSAIDs fail, but their efficacy has potentially been limited in previous trials by inclusion criteria requiring the presence of established, active disease. Now, not only patients with axial SpA (axSpA) with radiographic signs of sacroiliitis (that is, with ankylosing spondylitis), but also patients in whom structural damage is not-yet-visible radiographically (non-radiographic axSpA) can be included in trials of therapy for axSpA. TNF blockers, it seems already, are at least similarly effective in patients with non-radiographic axSpA as in those with established AS. Short symptom duration and a positive C-reactive protein test at baseline are currently the best predictors for a good response to TNF-blocking agents. Biologic agents besides anti-TNF therapies have so far failed in the treatment of axSpA. New bone formation seems currently to be best prevented by NSAIDs, not by TNF blockers. Whether earlier effective treatment of bony inflammation with anti-TNF therapy will be able to prevent ossification at a later stage has yet to be determined. New classification criteria for peripheral SpA will also allow treatment trials to be conducted more systematically than has previously been possible in this subgroup of patients. SN - 1759-4804 UR - https://www.unboundmedicine.com/medline/citation/22487798/Developments_in_therapies_for_spondyloarthritis_ L2 - http://dx.doi.org/10.1038/nrrheum.2012.40 DB - PRIME DP - Unbound Medicine ER -