Developments in therapies for spondyloarthritis

Nat Rev Rheumatol. 2012 Apr 10;8(5):280-7. doi: 10.1038/nrrheum.2012.40.


First-line therapy for spondyloarthritis (SpA) has not yet altered in the wake of new classification criteria; NSAIDs and physical therapy are recommended. Anti-TNF agents can be used when NSAIDs fail, but their efficacy has potentially been limited in previous trials by inclusion criteria requiring the presence of established, active disease. Now, not only patients with axial SpA (axSpA) with radiographic signs of sacroiliitis (that is, with ankylosing spondylitis), but also patients in whom structural damage is not-yet-visible radiographically (non-radiographic axSpA) can be included in trials of therapy for axSpA. TNF blockers, it seems already, are at least similarly effective in patients with non-radiographic axSpA as in those with established AS. Short symptom duration and a positive C-reactive protein test at baseline are currently the best predictors for a good response to TNF-blocking agents. Biologic agents besides anti-TNF therapies have so far failed in the treatment of axSpA. New bone formation seems currently to be best prevented by NSAIDs, not by TNF blockers. Whether earlier effective treatment of bony inflammation with anti-TNF therapy will be able to prevent ossification at a later stage has yet to be determined. New classification criteria for peripheral SpA will also allow treatment trials to be conducted more systematically than has previously been possible in this subgroup of patients.

Publication types

  • Review

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antibodies, Monoclonal / therapeutic use
  • Antirheumatic Agents / therapeutic use*
  • Biological Products / therapeutic use
  • Drug Resistance
  • Drug Therapy, Combination
  • Drugs, Investigational / pharmacology
  • Female
  • Germany
  • Humans
  • Male
  • Needs Assessment
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Severity of Illness Index
  • Spondylarthritis / diagnosis
  • Spondylarthritis / drug therapy
  • Spondylitis, Ankylosing / diagnosis*
  • Spondylitis, Ankylosing / drug therapy*
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*


  • Anti-Inflammatory Agents, Non-Steroidal
  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Biological Products
  • Drugs, Investigational
  • Tumor Necrosis Factor-alpha