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New evidence on the management of spondyloarthritis.
Nat Rev Rheumatol 2016; 12(5):282-95NR

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for patients with symptomatic axial spondyloarthritis (SpA), who seem to respond best if treated early in the course of disease. The effect of NSAIDs on radiographic disease progression is less clear. Conventional disease-modifying antirheumatic drugs (DMARDs) are not recommended in the treatment of axial SpA, either alone or in combination with TNF blockers. Patients with nonradiographic axial SpA (nr-axSpA) seem to respond as well to TNF blockers as do patients with radiographic axial SpA (ankylosing spondylitis (AS)). However, patients with nr-axSpA should, in addition to a high severity of symptoms, also have objective signs of inflammation, detectable by MRI or by C-reactive protein testing, to be treated with TNF blockers. Whether early TNF-blocker treatment can retard new bone formation needs clarification. In clinical trials, anti-IL-17 agents and TNF blockers showed similar efficacy in patients with AS. The potential of IL-23 blockade for treatment of axial SpA needs to be further investigated. Treatment options for peripheral SpA have been much less thoroughly investigated than those for axial SpA. However, some data indicate that TNF blockers are effective for treating peripheral arthritis, enthesitis and dactylitis, the typical manifestations of peripheral SpA.

Authors+Show Affiliations

Rheumatology, Medical Department I, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany.Rheumatology, Medical Department I, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27052489

Citation

Sieper, Joachim, and Denis Poddubnyy. "New Evidence On the Management of Spondyloarthritis." Nature Reviews. Rheumatology, vol. 12, no. 5, 2016, pp. 282-95.
Sieper J, Poddubnyy D. New evidence on the management of spondyloarthritis. Nat Rev Rheumatol. 2016;12(5):282-95.
Sieper, J., & Poddubnyy, D. (2016). New evidence on the management of spondyloarthritis. Nature Reviews. Rheumatology, 12(5), pp. 282-95. doi:10.1038/nrrheum.2016.42.
Sieper J, Poddubnyy D. New Evidence On the Management of Spondyloarthritis. Nat Rev Rheumatol. 2016;12(5):282-95. PubMed PMID: 27052489.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - New evidence on the management of spondyloarthritis. AU - Sieper,Joachim, AU - Poddubnyy,Denis, Y1 - 2016/04/07/ PY - 2016/4/8/entrez PY - 2016/4/8/pubmed PY - 2017/6/13/medline SP - 282 EP - 95 JF - Nature reviews. Rheumatology JO - Nat Rev Rheumatol VL - 12 IS - 5 N2 - Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for patients with symptomatic axial spondyloarthritis (SpA), who seem to respond best if treated early in the course of disease. The effect of NSAIDs on radiographic disease progression is less clear. Conventional disease-modifying antirheumatic drugs (DMARDs) are not recommended in the treatment of axial SpA, either alone or in combination with TNF blockers. Patients with nonradiographic axial SpA (nr-axSpA) seem to respond as well to TNF blockers as do patients with radiographic axial SpA (ankylosing spondylitis (AS)). However, patients with nr-axSpA should, in addition to a high severity of symptoms, also have objective signs of inflammation, detectable by MRI or by C-reactive protein testing, to be treated with TNF blockers. Whether early TNF-blocker treatment can retard new bone formation needs clarification. In clinical trials, anti-IL-17 agents and TNF blockers showed similar efficacy in patients with AS. The potential of IL-23 blockade for treatment of axial SpA needs to be further investigated. Treatment options for peripheral SpA have been much less thoroughly investigated than those for axial SpA. However, some data indicate that TNF blockers are effective for treating peripheral arthritis, enthesitis and dactylitis, the typical manifestations of peripheral SpA. SN - 1759-4804 UR - https://www.unboundmedicine.com/medline/citation/27052489/New_evidence_on_the_management_of_spondyloarthritis_ L2 - http://dx.doi.org/10.1038/nrrheum.2016.42 DB - PRIME DP - Unbound Medicine ER -