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. 2013 Feb;5(1):45-54.
doi: 10.1177/1759720X12468658.

Axial spondyloarthritis: is there a treatment of choice?

Denis Poddubnyy  1
Affiliations

Axial spondyloarthritis: is there a treatment of choice?

Denis Poddubnyy. Ther Adv Musculoskelet Dis. 2013 Feb.

Abstract

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly affecting the axial skeleton (sacroiliac joints and spine). Nonradiographic axSpA (axSpA without radiographic sacroiliitis) and ankylosing spondylitis (AS; radiographic form of axSpA) are considered nowadays as two consecutive stages of one disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) are highly effective against the major symptoms of axSpA (pain and stiffness) and may have disease-modifying properties including retarding progression of structural damage in the spine. Therefore, NSAIDs, unless contraindicated, are the treatment of choice for the majority of patients with axSpA. Beyond NSAIDs, only tumour necrosis factor (TNF) α blockers are effective and approved for the treatment of active axSpA. Several novel drugs (i.e. monoclonal antibodies targeting interleukin-17, interleukin-12/23, inhibitors of phosphodiesterase-4 and kinases), which might be effective in axSpA, are currently under investigation. Pharmacological therapy of axSpA should always be combined with nonpharmacological treatment including education and regular exercise/physiotherapy.

Keywords: ankylosing spondylitis; axial spondyloarthritis; nonsteroidal anti-inflammatory drugs; treatment; tumour necrosis factor α blocker.

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Conflict of interest statement

Conflict of interest statement: Denis Poddubnyy received consulting and speaking fees from Abbott, MSD, Pfizer, and UCB.

Figures

Figure 1.
Figure 1.
Summary of the ASAS/EULAR recommendations for treatment of AS. AS, ankylosing spondylitis; DMARD, disease-modifying antirheumatic drug; NSAIDs, nonsteroidal anti-inflammatory drug; TNF, tumour necrosis factor.
Figure 2.
Figure 2.
ASAS recommendations for the use of an anti-TNF agent in patients with axial SpA. AS, ankylosing spondylitis; ASAS, Assessment of Spondyloarthritis International Society; BASDAI, the Bath Ankylosing Spondylitis Disease Activity Index; CRP, C-reactive protein; DMARD, disease-modifying antirheumatic drug; ESR, erythrocyte sedimentation rate; MRI, magnetic resonance imaging; NSAID, nonsteroidal anti-inflammatory drug; SpA, spondyloarthritis; TNF, tumour necrosis factor.
See this image and copyright information in PMC

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