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Anti-tumour necrosis factor α therapy for ankylosing spondylitis: international experience
  1. J Braun1,
  2. J Sieper2,
  3. M Breban3,
  4. E Collantes-Estevez4,
  5. J Davis5,
  6. R Inman6,
  7. H Marzo-Ortega7,
  8. H Mielants8
  1. 1Rheumazentrum Ruhrgebie, UKBF, Free University, Berlin, Germany
  2. 2Department of Gastroenterology and Rheumatology, UKBF, Free University, Berlin, Germany
  3. 3Institut de Rhumatologie, Department of Immunology, Hôpital Cochin, Paris, France
  4. 4Department of Rheumatology, Hospital Universitario Reina Sofia, Cordoba, Spain
  5. 5University of California, San Francisco, San Francisco, California, USA
  6. 6University of Toronto, Toronto, Canada
  7. 7Rheumatology Research Unit, The University of Leeds, Leeds, UK
  8. 8Department of Rheumatology, Ghent University Hospital , Ghent, Belgium
  1. Correspondence to:
    Dr J Braun, Rheumazentrum Ruhrgebiet, Landgrafenstr. 15, 44652, Herne, and UKBF, Free University, Berlin, Germany;


The conventional approach to treatment of patients with spondyloarthritis (SpA), particularly ankylosing spondylitis (AS), has serious limitations, adding a sense of urgency to the evaluation of new treatments for these rheumatic disorders. Tumour necrosis factor α (TNFα) is a cytokine that has been shown to mediate inflammatory and regulatory activities in SpA and other immune mediated diseases, including other arthritides and inflammatory bowel disease. Positive results have been reported in several international open label and randomised controlled trials of infliximab and etanercept, the two main biological agents targeting TNFα, which have included approximately 300 patients with SpA. Specifically, TNFα-directed therapy resulted in significant improvements in disease activity, function, and quality of life in these patients, most of whom had AS and received infliximab. Preliminary evidence from open label, long term extension trials suggests clinical benefit with continued use. Serious side effects were rare and consistent with experience from patient groups receiving infliximab or etanercept treatment for inflammatory bowel disease or rheumatoid arthritis. Together, these findings herald an age of more effective treatment of patients with AS with anti-TNFα and other emerging biological agents.

  • ankylosing spondylitis
  • etanercept
  • infliximab
  • tumour necrosis factor α
  • AS, ankylosing spondylitis
  • BASDAI, Bath AS Disease Activity Index
  • BASFI, Bath AS Functional Index
  • BASGI, Bath AS Global Index
  • CRP, C reactive protein
  • CT, computed tomography
  • DMARD, disease modifying antirheumatic drug
  • ESR, erythrocyte sedimentation rate
  • IFNγ, interferon γ
  • IL, interleukin
  • MRI, magnetic resonance imaging
  • NSAID, non-steroidal anti-inflammatory drug
  • PsA, psoriatic arthritis
  • QoL, quality of life
  • RA, rheumatoid arthritis
  • SF-36, Short Form-36
  • SpA, spondyloarthritis
  • TNFα, tumour necrosis factor α
  • VAS, visual analogue scale

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