Currently, etanercept (Enbrel) is the only FDA approved tumor necrosis factor inhibiting (TNF-a) therapy for Ankylosing Spondylitis. Remicade and Humira have been prescribed off-label, having been approved for use with other conditions, but they have not as yet been approved for AS. Recently, an international team of rheumatologists and researches from both Europe and North America developed guidelines to provide standards for TNF therapy in AS patients.

According to the guidelines, a diagnosis of AS must be confirmed by x-ray. This is to be absolutely sure of the existence of the condition.

Next, disease activity, function and the severity of a patient’s AS are important in judging whether or not to start TNF blocking therapy. But those judgments can be somewhat subjective if not put into a testable format. Two tests, the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), and BASFI (Bath Ankylosing Spondylitis Functional Index) were created in order to determine disease activity and how well a patient is currently functioning with AS.

In order to be treated with TNF-a medications, it is suggested that patients should fill out the aforementioned indices. Upon a physician’s review of their score, a patient might qualify for the use of TNF blockers. But, before they do, a patient must also have failed two NSAIDs, either because they did not respond to the medication or could not tolerate the medication. Normally, the NSAIDS treatment regime lasts at least three months.