[Spondylarthropathies and anti-TNFalpha drugs]

Abstract

Purpose: Spondylarthropathies are a heterogeneous group of disorders including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel disease, and undifferentiated spondylarthropathies. These diseases are characterised by inflammation in the spine, sacroiliac joints, entheses, peripheral joints, and a strong association with HLA-B27; they may cause severe destruction and/or ankylosis in a minority of patients. Conventional treatment includes non steroidal anti-inflammatory drugs, corticosteroid injections, and DMARDs such as sulfasalazine in patients with peripheral arthritis. TNFalpha appears as an important actor in the pathogenesis of spondylarthropathies.

Method and results: Among the anti-TNFalpha drugs, etanercept and infliximab have proved to be effective in the symptomatic treatment of ankylosing spondylitis and psoriatic arthritis. A clinical relapse was observed within a few weeks after treatment discontinuation in a majority of patients. Potential beneficial effects on the destructive and/or ankylosing evolution remains to be confirmed.

Conclusions: Patients with active, severe and refractory spondylarthropathies are potential candidates for treatment with anti-TNFalpha drugs. Taking into account not only the efficacy but also the side effects, with rare but potentially severe complications such as tuberculosis or other opportunistic infections, and the relatively high cost of these drugs, preliminary criteria for the initiation, monitoring and discontinuation of these drugs in the treatment of spondylarthropathies were proposed. Long-term follow-up in large populations of patients with spondylarthropathies is necessary to better define the benefit/risk/cost ratio of anti-TNFalpha drugs.