Update on TNF inhibitors for the spondyloarthropathies

Tumor necrosis factor (TNF) inhibitors have had a dramatic effect on treatment options, diagnostic approach and numerous aspects of clinical care, according to a recent review of their use in the spondyloarthropathies.In their paper, lead author Dr Arthur Kavanaugh and colleagues review data from clinical trials with TNF inhibitors in ankylosing spondylitis and psoriatic arthritis.The group reflect that the rationale for the use of TNF inhibitors in the spondyloarthropathies includes "immunopathophysiologic evidence suggesting a key role for TNF; unmet clinical need, including the need for a greater appreciation of the severity and impact of spondyloarthropathies on affected patients and lack of alternative therapies, particularly for spondylitis."The growing experience with TNF inhibitors in other conditions, particularly rheumatoid arthritis, is identified as stimulating the use of TNF inhibitors in patients with spondyloarthropathy, (due to TNF commonality of TNF in the initiation and sustenance of articular and systemic inflammation).The authors report that treatment with TNF inhibitors has not only resulted in substantial improvement in the signs and symptoms of arthritis but has also improved functional status and quality of life in ankylosing spondylitis and psoriatic arthritis. Dr Kavanaugh's group add that improvements in associated inflammatory features, such as enthesitis in psoriatic arthritis and uveitis in ankylosing spondylitis, have also been observed.However, the paper highlights that some unanswered qestions remain, including whether there will be variable responses to treatment in heterogeneous groups of patients, such as those with early disease and that qestions remain about the optimal treatment approach and cost benefits.Overall the reviewers consider, "(TNF inhibitor) treatment has been shown to inhibit the progression of radiographic joint damage in psoriatic arthritis and to attenuate spinal inflammation in ankylosing spondylitis. The notable success of tumor necrosis factor inhibitors has not only changed the treatment paradigms for these conditions but has also stimulated studies aimed at improving diagnosis, prognostic stratification, and other aspects of clinical care."Reference...