An article in the July 2004 issue of Current Opinion in Rheumatology entitled, "Recent advances in the treatment of the spondyloarthopathises," states that there is renewed interest in spondylitis (also known as spondyloarthropathy or spondyloarthritis) family of disease. The article attributes this to the new "biologic era" of treatment, referring in part to the group of TNF-a inhibitors now available to treat spondylitis and rheumatoid arthritis. The trio of TNF-a blocker medications are Enbrel® (etanercept), which is currently the only FDA approved biologic treatment for Ankylosing Spondylitis, Remicade® (infliximab), which is currently under review for FDA approval, and Humira® (adalimumab), which is only approved thus far for Rheumatoid Arthritis.

Supervised exercise programs and NSAIDs are still a staple of treatment, but the article argues that, despite the absence of a cure for the disease, the aforementioned biologic agents are emerging as the best therapeutic option available for patients with moderate to severe AS. Having been evaluated in a number of randomized, controlled trials, the TNF-a blockers have been demonstrated to be safe and effective in the short-term management of ankylosing spondylitis and psoriatic arthritis. The article concedes that results from longer-term trials have yet to determine the disease-modifying properties of these medications as well as the safety of using these biologic treatments for extended periods of time.

According to a study entitled, "Etanercept: in ankylosing spondylitis," done by Adis International, Enbrel, "significantly improved health-related quality of life in patients with ankylosing spondylitis compared with placebo." A study done in Germany by Rheumazentrum Ruhrgebiet, Landgrafenstr, cites, "there is now accumulating evidence that the new anti-TNF alpha agents do not only reduce signs and symptoms of AS caused by inflammation but they may also diminish structural damage."

As with all medications, there are potential side effects. Dr. Paul Peloso explains, "The main side effect we see on a regular basis is increased infections. We need to test for TB before we use TNF-blockers, and we need to treat TB if a patient has it. There is a risk of increased sinus infections, bronchitis and pneumonia. Other issues that are still being investigated are the risk of lymphoma, congestive heart failure and multiple sclerosis. We are still trying to figure out how important those things are after TNF-blockers."

The new treatments show promise, but only time will yield the answers to the questions concerning biological treatment's full potential efficacy and safety. Says Dr. John Reveille, "The TNF-a blockers being used in AS seem to stop or slow pathological radiographic progression in many AS patients." He adds, "there is not yet long-term data on the safety profile...Whether or not they will continue to work over time, remains to be seen."

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References: Liu, Yan a; Cortinovis, Daniela a; Stone, Millicent A a,b. "Recent advances in the treatment of the spondyloarthropathies." Current Opinion in Rheumatology. 16(4):357-365, July 2004; Brandt J, Sieper J, Braun J. "Treatment of ankylosing spondylitis and undifferentiated spondyloarthritis with TNF alpha-antagonists." Rheumazentrum Ruhrgebiet, Landgrafenstr. 15, 44652 Herne, Germany; McCormack PL, Wellington K. "Etanercept: in ankylosing spondylitis." Adis International Inc., Yardley, Pennsylvania 19067, USA;