Toxicological considerations in the treatment of axial spondylo-arthritis

Expert Opin Drug Metab Toxicol. 2020 Aug;16(8):663-672. doi: 10.1080/17425255.2020.1783240. Epub 2020 Jun 27.


Introduction: The first-line treatment of axial spondyloarthritis (SpA) is with non-steroidal anti-inflammatory drugs (NSAIDs) and is followed by tumor necrosis factor (TNF) inhibitors (the main treatment for patients not responding to NSAIDs) or drugs targetting the IL-23/IL-17 pathway. The efficacy of disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate and sulfasalazine (SSZ) has not been demonstrated, although SSZ can be considered in patients with concomitant peripheral arthritis.

Areas covered: This review describes the beneficial and toxicological effects of the drugs used to treat axial SpA.

Expert commentary: Growing concerns about the safety of anti-TNF drugs underline the need to ensure that all clinicians are capable of taking appropriate preventive action and adequately treating affected patients.

Keywords: Axial SpA; anti-IL17 drugs; anti-TNF drugs; cardiovascular disease; infections.

Publication types

  • Review

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / pharmacology
  • Antirheumatic Agents / administration & dosage
  • Antirheumatic Agents / adverse effects
  • Antirheumatic Agents / pharmacology
  • Humans
  • Interleukin-17 / immunology
  • Interleukin-23 / immunology
  • Spondylarthritis / drug therapy*
  • Spondylarthritis / physiopathology
  • Tumor Necrosis Factor Inhibitors / administration & dosage*
  • Tumor Necrosis Factor Inhibitors / adverse effects
  • Tumor Necrosis Factor Inhibitors / pharmacology


  • Anti-Inflammatory Agents, Non-Steroidal
  • Antirheumatic Agents
  • Interleukin-17
  • Interleukin-23
  • Tumor Necrosis Factor Inhibitors