Recent experience with anti-tumor necrosis factor-a (TNF-a) medications prompted the Spondyloarthritis Research Consortium of Canada (SPARCC) to evaluate evidence of these drugs' efficacy, safety, and appropriate use in the spondyloarthropathies (SpA). SPARCC is an information association of rheumatologist members of the Canadian Rheumatology Association (CRA) with a special interest in therapeutics and outcomes research in SpA. Two of the Spondylitis Association of America's Medical and Scientific Advisory Board members, Walter P. Maksymowych and Robert D. Inman, are a part of the SPARCC.

According to the group, SpA represents a group of related diseases characterized by their association with HLA-B27 and the development of sacroiliitis and enthesisis. Functional impairment, disability, and loss of quality of life may resemble that observed in rheumatoid arthritis. The group based their recommendations on clinical evidence found through Medline, articles from the American College of Rheumatology and the European Congress of Rheumatology 1999-2002 annual meetings, clinical trials and studies, and recommendations from the consensus of SPARCC members when scientific literature was incomplete.

The Therapeutics Committee of the CRA has endorsed the following recommendations:

• Infliximab (Remicade) and etanercept (Enbrel) are indicated for reduction of signs and symptoms of moderate to severely active SpA in patients who have had an inadequate response to maximal doses of more than two nonsteroidal anti-inflammatory drugs (NSAIDs) over a three-month period of observation.
  
• Either sulfasalazine or methotrexate is indicated in those with predominantly active peripheral arthritis. Current evidence supports their use as monotherapy for at least one year. NSAID and/or therapy with either sulfasalazine or methotrexate can be continued concomitantly.
  
• There is no evidence addressing potential advantages or disadvantages of combining methotrexate with anti-TNF therapy for SpA. Recommended doses for adults are: infliximab 5 mg/kg at 0, 2, and 6 weeks and every 8 weeks thereafter; etanercept 25mg twice weekly.
  
• No therapy has been shown to slow progression of axial disease in SpA, and prognostic factors for determining response to therapy remain to be determined.
  
• Lastly, "It is the position of the CRA that all therapeutic options should be equally available according to the best judgements of the treating physician and the informed decision of the patient."

  The abstract can be online at The Journal of Rheumatology.