Hanyang Med Rev.  2012 May;32(2):77-82. 10.7599/hmr.2012.32.2.77.

Tailored Treatment of Ankylosing Spondylitis

• Kim TJ

• KMID: 2168200
• DOI: http://doi.org/10.7599/hmr.2012.32.2.77

Abstract

Ankylosing spondylitis (AS) is a chronic rheumatic disease of the axial skeleton (spine and sacroiliac joints). Only nonsteroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor (TNF) alpha inhibitors have currently been shown as effective for the treatment of signs and symptoms of active AS with predominant axial involvement. In contrast to rheumatoid arthritis (RA), disease-modifying anti-rheumatic drugs (DMARDs) play only a minor role in the management of AS and only in cases with peripheral joint involvement. Herein, this review describes the pharmacological and nonpharmacological management of AS, based on recent international recommendations for the management of AS by the Assessment of Spondyloarthritis (ASAS) group. Despite the overall demonstrated efficacy of currently available treatments for AS, up to 40% of treated patients do not achieve an acceptable clinical improvement during therapy. Therefore, this article also reviews the evidence regarding the potential role for new agents targeting B-cells, T-cells, interleukin (IL)-1, IL-6, IL-17, and IL-12/23 in patients with AS.

Keyword

Spondylitis, Ankylosing; Disease Management; Therapeutucs; Biological Agents

MeSH Terms

Antirheumatic Agents
Arthritis, Rheumatoid
B-Lymphocytes
Biological Agents
Disease Management
Humans
Interleukin-17
Interleukin-6
Interleukins
Joints
Rheumatic Diseases
Skeleton
Spondylitis, Ankylosing
T-Lymphocytes
Tumor Necrosis Factor-alpha
Antirheumatic Agents
Biological Agents
Interleukin-17
Interleukin-6
Interleukins
Tumor Necrosis Factor-alpha

Figure

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  Fig. 1 ASAS Classification Criteria for Axial Spondyloarthritis (SpA) (Ref. 10 with permission from BMJ Publishing Group). HLA-B27, human leukocyte antigen B27; CRP, C-reactive protein; NSAIDs, nonsteroidal anti-inflammatory drugs.

• 

  Fig. 2 ASAS/EULAR recommendation for the management of AS (Ref. 21 with permission from BMJ Publishing Group). ASAS/EULAR, Assessment Ankylosing Spondylitis/European League Against Rheumatism; AS, ankylosing spondylitis; NSAIDs, nonsteroidal anti-inflammatory drugs; TNF, tumor necrosis factors.

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