Major changes anticipated in management of spondylarthropathies

Recent major advances in the diagnosis and management of spondylarthropathies have been presented at the 8th annual meeting of the European Congress of Rheumatology. Presenting at the plenary session, Spondylarthropathies: At the Crossroads of Imaging, Pathology, and Novel Therapeutics Professor Joachim Sieper (Charite Berlin, Campus Benjamin Franklin) touches on the use of imaging techniques for early diagnosis, including advances in magnetic resonance imaging "allowing visualization of acute inflammation in the sacroiliac joints months or years before radiographic evidence of chronic joint changes are detectable".The session continues by stressing that early diagnosis of ankylosing spondylitis is particularly important because effective treatments are now available. "The tumor necrosis factor [(TNF)] blocking agents are very potent anti-inflammatory drugs that are extremely effective in patients with active AS," Professor Sieper adds.Supporting this perspective, data is cited from a recent multi-centre study in which 279 ankylosing spondylitis patients were randomized to treatment with infliximab, 5 mg/kg, or placebo for 24 weeks. On assessment with ankylosing spondylitis (ASAS) criteria, 61.2% of patients receiving the TNF blocking drug achieved an ASAS20 response, compared with 19.2% of placebo patients.In a second study 277 patients were randomised to placebo or etanercept 25 mg subcutaneously twice weekly for 24 weeks. ASAS20 was achieved by 57% receiving etanercept, compared with 22% receiving placebo."TNF blockers reduce acute inflammation of spine and sacroiliac joints as seen on MRI, rapidly and consistently over a time period of at least two years. They also increase bone mineral density after only a short period of treatment.""Whether and how this also inhibits osteoproliferation, such as of syndesmophytes, is currently still a matter of debate," Professor Sieper concludes.Reference...