Rheumatology International

, 29:1123 | Cite as

A systematic medline analysis of therapeutic approaches in ankylosing spondylitis

  • L. GohEmail author
  • A. Samanta


Ankylosing spondylitis (AS) is a chronic inflammatory disorder involving the sacroiliac joints (SIJs), spine and less frequently the peripheral joints. Traditionally, it is well recognised that AS is a challenging disease to manage due to the lack of effective therapeutic options. Current evidence would suggest this has changed and there are now a number of therapies available that provide persistent control of inflammatory symptoms with improvement in daily function. NSAIDs remain the first step in patient treatment. Sulphasalazine may be effective in peripheral arthritis and there are emerging data to support its use in early inflammatory back pain. Studies have shown that pamidronate and steroid injection into SIJ have a symptom-modifying effect in AS. Current data suggest that anti-TNF treatment promises early benefit which is likely to continue in the longer term. Treatment with biologics should be considered sooner rather than later in the management of AS.


Ankylosing spondylitis (AS) Treatment Review 



We are grateful to K.J. Goh for his considerable support during preparation of this manuscript. The authors have declared no conflicts of interest.


  1. 1.
    Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J (2003) Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 23(2):61–66PubMedGoogle Scholar
  2. 2.
    Carette S, Graham D, Little H, Rubenstein J, Rosen P (1983) The natural disease course of ankylosing spondylitis. Arthritis Rheum 26(2):186–190. doi: 10.1002/art.1780260210 PubMedCrossRefGoogle Scholar
  3. 3.
    Gran JT, Skomsvoll JF (1997) The outcome of ankylosing spondylitis; a study of 100 patients. Br J Rheumatol 36(7):766–771. doi: 10.1093/rheumatology/36.7.766 PubMedCrossRefGoogle Scholar
  4. 4.
    Ward MM (1999) Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res 12(4):247–255. doi: 10.1002/1529-0131(199908)12:4<247::AID-ART3>3.0.CO;2-H PubMedCrossRefGoogle Scholar
  5. 5.
    Dagfinrud H, Vollestad NK, Loge JH, Kvien TK, Mengshoel AM (2005) Fatique in patients with ankylosing spondylitis: a comparison with the general population and associations with clinical and self-reported measures. Arthritis Rheum 53(1):5–11. doi: 10.1002/art.20910 PubMedCrossRefGoogle Scholar
  6. 6.
    Ward MM (2002) Functional disability predicts total costs in patients with ankylosing spondylitis. Arthritis Rheum 46(1):223–231. doi: 10.1002/1529-0131(200201)46:1<223::AID-ART498>3.0.CO;2-# PubMedCrossRefGoogle Scholar
  7. 7.
    Kobelt G, Andlin-Sobocki P, Brophy S, Jonsson L, Calin A, Braun J (2004) The burden of ankylosing spondylitis and the cost-effectiveness of treatment with infliximab (remicade). Rheumatology 43(9):1158–1166. doi: 10.1093/rheumatology/keh271 PubMedCrossRefGoogle Scholar
  8. 8.
    Boonen A, van der Heijde D, Landewe R, Guillemin F, Rutten-van Molken M, Dougados M et al (2003) Direct costs of ankylosing spondylitis and its determinants: an analysis among three European countries. Ann Rheum Dis 62(8):732–740. doi: 10.1136/ard.62.8.732 PubMedCrossRefGoogle Scholar
  9. 9.
    van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368. doi: 10.1002/art.1780270401 PubMedCrossRefGoogle Scholar
  10. 10.
    Rudwaleit M, van der Heijde D, Khan MA, Braun J, Sieper J (2004) How to diagnose axial spondyloarthritis early. Ann Rheum Dis 63(5):535–543. doi: 10.1136/ard.2003.011247 PubMedCrossRefGoogle Scholar
  11. 11.
    Rudwaleit M, Listing J, Brandt J, Braun J, Sieper J (2004) Prediction of a major clinical response (BASDAI 50) to tumour necrosis factor alpha blockers in ankylosing spondylitis. Ann Rheum Dis 63(6):665–670. doi: 10.1136/ard.2003.016386 PubMedCrossRefGoogle Scholar
  12. 12.
    Dougados M, Dijkmans B, Khan M, Maksymowych W, van der Linden S, Brandt J (2002) Conventional treatment for ankylosing spondylitis. Ann Rheum Dis 61(Suppl 3):40–50Google Scholar
  13. 13.
    Shekelle PG, Woolf SH, Eccles M, Grimshaw J (1999) Clinical guidelines: developing guidelines. BMJ 318(7183):593–596PubMedGoogle Scholar
  14. 14.
    Brandt J, Haibel H, Cornely D et al (2000) Successful treatment of active ankylosing spondylitis with anti-tumour necrosis factor alpha monoclonal antibody infliximab. Arthritis Rheum 43(6):1346–1352. doi: 10.1002/1529-0131(200006)43:6<1346::AID-ANR18>3.0.CO;2-E PubMedCrossRefGoogle Scholar
  15. 15.
    Van Den Bosch F, Kruithof E, Baeten D, De Keyser F, Mielants H, Veys EM (2000) Effects of a loading dose regimen of three infusions of chimeric monoclonal antibody to tumour necrosis factor (infliximab) in spondyloarthropathy: an open pilot study. Ann Rheum Dis 59(6):428–433. doi: 10.1136/ard.59.6.428 PubMedCrossRefGoogle Scholar
  16. 16.
    Kruithof E, Van den Bosch F, Baeten D et al (2002) Repeated infusions of infliximab, a chimeric anti-TNF alpha monoclonal antibody, in patients with active spondyloarthropathy: one year follow up. Ann Rheum Dis 61(3):207–212. doi: 10.1136/ard.61.3.207 PubMedCrossRefGoogle Scholar
  17. 17.
    Stone M, Salonen D, Lax M, Payne U, Lapp V, Inman R (2001) Clinical and imaging correlates of response to treatment with infliximab in patients with ankylosing spondylitis. J Rheumatol 28(7):1605–1614PubMedGoogle Scholar
  18. 18.
    Maksymowych WP, Jhangri GS, Lambert RG et al (2002) Infliximab in ankylosing spondylitis: a prospective observational inception cohort analysis of efficacy and safety. J Rheumatol 29(5):959–965PubMedGoogle Scholar
  19. 19.
    Braun J, Brandt J, Listing J et al (2002) Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet 359(9313):1187–1193. doi: 10.1016/S0140-6736(02)08215-6 PubMedCrossRefGoogle Scholar
  20. 20.
    Braun J, Brandt J, Listing J et al (2003) Long term efficacy and safety of infliximab in the treatment of ankylosing spondylitis: an open, observational, extension study of a three-month, randomized, placebo-controlled trial. Arthritis Rheum 48(8):2224–2233. doi: 10.1002/art.11104 PubMedCrossRefGoogle Scholar
  21. 21.
    Braun J, Brandt J, Listing J et al (2005) Two year maintenance of efficacy and safety of infliximab in the treatment of ankylosing spondylitis. Ann Rheum Dis 64(2):229–234. doi: 10.1136/ard.2004.025130 PubMedCrossRefGoogle Scholar
  22. 22.
    Braun J, Baraliakos X, Brandt J et al (2005) Persistent clinical response to the anti TNF-alpha antibody infliximab in patients with ankylosing spondylitis over 3 years. Rheumatology 44(5):670–676. doi: 10.1093/rheumatology/keh584 PubMedCrossRefGoogle Scholar
  23. 23.
    Braun J, Baraliakos X, Listing J et al (2008) Persistent clinical efficacy and safety of anti-tumour necrosis factor alpha therapy with infliximab in patients with ankylosing spondylitis over 5 years: evidence for different types of response. Ann Rheum Dis 67(3):340–345. doi: 10.1136/ard.2007.075879 PubMedCrossRefGoogle Scholar
  24. 24.
    Sieper J, Baraliakos X, Listing J et al (2005) Persistent reduction of spinal inflammation as assessed by magnetic resonance imaging in patients with ankylosing spondylitis after 2 years of treatment with the anti-tumour necrosis factor agent infliximab. Rheumatology 44(12):1525–1530. doi: 10.1093/rheumatology/kei046 PubMedCrossRefGoogle Scholar
  25. 25.
    Braun J, Baraliakos X, Golder W et al (2003) Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system. Arthritis Rheum 48(4):1126–1136. doi: 10.1002/art.10883 PubMedCrossRefGoogle Scholar
  26. 26.
    Marzo-Ortega H, McGonagle D, Jarrett S et al (2005) Infliximab in combination with methotrexate in active ankylosing spondylitis: a clinical and imaging study. Ann Rheum Dis 64(11):1568–1575. doi: 10.1136/ard.2004.022582 PubMedCrossRefGoogle Scholar
  27. 27.
    Perez-Guijo VC, Cravo AR, Castro Mdel C, Font P, Munoz-Gomariz E, Collantes-Estevez E (2007) Increased efficacy of infliximab associated with methotrexate in ankylosing spondylitis. Joint Bone Spine 74(3):254–258. doi: 10.1016/j.jbspin.2006.08.005 PubMedCrossRefGoogle Scholar
  28. 28.
    Baraliakos X, Listing J, Rudwaleit M, Brandt J, Sieper J, Braun J (2005) Radiographic progression in patients with ankylosing spondylitis after 2 years of treatment with the tumour necrosis factor alpha antibody infliximab. Ann Rheum Dis 64(10):1462–1466. doi: 10.1136/ard.2004.033472 PubMedCrossRefGoogle Scholar
  29. 29.
    Baraliakos X, Listing J, Brandt J et al (2007) Radiographic progression in patients with ankylosing spondylitis after 4 yrs of treatment with the anti-TNF-alpha antibody infliximab. Rheumatology 46(9):1450–1453. doi: 10.1093/rheumatology/kem166 PubMedCrossRefGoogle Scholar
  30. 30.
    van der Heijde D, Dijkmans B, Geusens P et al (2005) Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomised, placebo-controlled trial (ASSERT). Arthritis Rheum 52(2):582–591. doi: 10.1002/art.20852 PubMedCrossRefGoogle Scholar
  31. 31.
    Baraliakos X, Listing J, Brandt J et al (2005) Clinical response to discontinuation of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab. Arthritis Res Ther 7(3):439–444. doi: 10.1186/ar1693 CrossRefGoogle Scholar
  32. 32.
    Baraliakos X, Listing J, Rudwaleit M et al (2007) Safety and efficacy of readministration of infliximab after long term continuous therapy and withdrawal in patients with ankylosing spondylitis. J Rheumatol 34(3):510–515PubMedGoogle Scholar
  33. 33.
    Gossec L, Le Henanff A, Breban M et al (2006) Continuation of treatment with infliximab in ankylosing spondylitis: 2-yr open follow up. Rheumatology 45(7):859–862. doi: 10.1093/rheumatology/kel015 PubMedCrossRefGoogle Scholar
  34. 34.
    Keeling S, Oswald A, Russell AS, Maksymowych WP (2006) Prospective observational analysis of the efficacy and safety of low-dose (3 mg/kg) Infliximab in ankylosing spondylitis: 4-year follow up. J Rheumatol 33(3):558–561PubMedGoogle Scholar
  35. 35.
    Cheung PP, Tymms KE, Wilson BJ et al (2008) Inflximab in severe active ankylosing spondylitis with spinal ankylosis. Intern Med J 38(6):396–401. doi: 10.1111/j.1445-5994.2007.01599.x PubMedCrossRefGoogle Scholar
  36. 36.
    Marzo-Ortega H, McGonagle D, O’Connor P, Emery P (2001) Efficacy of etanercept in the treatment of the entheseal pathology in resistant Spondylarthropathy: a clinical and magnetic resonance imaging study. Arthritis Rheum 44(9):2112–2117. doi: 10.1002/1529-0131(200109)44:9<2112::AID-ART363>3.0.CO;2-H PubMedCrossRefGoogle Scholar
  37. 37.
    Gorman JD, Sack KE, Davis JC (2002) Treatment of ankylosing spondylitis by inhibition of tumour necrosis factor alpha. N Engl J Med 346(18):1349–1356. doi: 10.1056/NEJMoa012664 PubMedCrossRefGoogle Scholar
  38. 38.
    Davis JC, Van der Heijde D, Braun J et al (2003) Recombinant human tumour necrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomised controlled trial. Arthritis Rheum 48(11):3230–3236. doi: 10.1002/art.11325 PubMedCrossRefGoogle Scholar
  39. 39.
    Baraliakos X, Davis J, Tsuji W, Braun J (2005) Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis before and after therapy with the tumor necrosis factor alpha receptor fusion protein etanercept. Arthritis Rheum 52(4):1216–1223. doi: 10.1002/art.20977 PubMedCrossRefGoogle Scholar
  40. 40.
    Davis JC, Van der Heijde DM, Braun J et al (2005) Sustained durability and tolerability of etanercept in ankylosing spondylitis for 96 weeks. Ann Rheum Dis 64(11):1557–1562. doi: 10.1136/ard.2004.035105 PubMedCrossRefGoogle Scholar
  41. 41.
    Davis JC, Van der Heijde DM, Braun J et al (2007) Efficacy and safety of up to 192 weeks of etanercept therapy in patients with ankylosing spondylitis. Ann Rheum Dis 67(3):346–352. doi: 10.1136/ard.2007.078139 PubMedCrossRefGoogle Scholar
  42. 42.
    Brandt J, Khariouzov A, Listing J et al (2003) Six-month results of a double- blind, placebo-controlled trial of etanercept treatment in patients with active ankylosing spondylitis. Arthritis Rheum 48(6):1667–1675. doi: 10.1002/art.11017 PubMedCrossRefGoogle Scholar
  43. 43.
    Brandt J, Listing J, Haibel H et al (2005) Long-term efficacy and safety of etanercept after readministration in patients with active ankylosing spondylitis. Rheumatology 44(3):342–348. doi: 10.1093/rheumatology/keh475 PubMedCrossRefGoogle Scholar
  44. 44.
    Baraliakos X, Brandt J, Listing J et al (2005) Outcome of patients with active ankylosing spondylitis after twor years of therapy with etanercept: clinical and magnetic esonance imaging Data. Arthritis Rheum 53(6):856–863. doi: 10.1002/art.21588 PubMedCrossRefGoogle Scholar
  45. 45.
    Rudwaleit M, Baraliakos X, Listing J, Brandt J, Sieper J, Braun J (2005) Magnetic resonance imaging of the spine and the sacroiliac joint in ankylosing spondylitis and undifferentiated spondyloarthritis during treatment with etanercept. Ann Rheum Dis 64(9):1305–1310. doi: 10.1136/ard.2004.032441 PubMedCrossRefGoogle Scholar
  46. 46.
    Calin A, Dijkmans BA, Emery P et al (2004) Outcomes of a multicentre randomised clinical trial of etanercept to treat ankylosing spondylitis. Ann Rheum Dis 63(12):1594–1600. doi: 10.1136/ard.2004.020875 PubMedCrossRefGoogle Scholar
  47. 47.
    Braun J, McHugh N, Singh A, Wajdula JS, Sato R (2007) Improvement in patient- reported outcomes for patients with ankylosing spondylitis treated with etanercept 50 mg once-weekly and 25 mg twice-weekly. Rheumatology 46(6):999–1004. doi: 10.1093/rheumatology/kem069 PubMedCrossRefGoogle Scholar
  48. 48.
    Haibel H, Rudwaleit M, Brandt HC et al (2006) Adalimumab reduces spinal symptoms in active ankylosing spondyltis: clinical and magnetic resonance imaging results of a fifty-two week open-label trial. Arthritis Rheum 54(2):678–681. doi: 10.1002/art.21563 PubMedCrossRefGoogle Scholar
  49. 49.
    van der Heijde D, Kivitz A, Schiff MH et al (2006) Efficacy and safety of adalimumab in patients with ankylosing spondylitis: results of a multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 54(7):2136–2146. doi: 10.1002/art.21913 PubMedCrossRefGoogle Scholar
  50. 50.
    van der Heijde D, Pangan AL, Schiff MH et al (2008) Adalimumab effectively reduces the signs and symptoms of active ankylosing spondylitis in patients with total spinal ankylosis. Ann Rheum Dis 67(9):1218–1221. doi: 10.1136/ard.2007.082529 PubMedCrossRefGoogle Scholar
  51. 51.
    Tan AL, Marzo-Ortega H, O’ Connor P, Fraser A, Emery P, McGonagle D (2004) Efficacy of anakinra in active ankylosing spondylitis: a clinical and magnetic resonance imaging study. Ann Rheum Dis 63(9):1041–1045. doi: 10.1136/ard.2004.020800 PubMedCrossRefGoogle Scholar
  52. 52.
    Haibel H, Rudwaleit M, Listing J, Sieper J (2005) Open label trial of anakinra in active ankylosing spondylitis over 24 weeks. Ann Rheum Dis 64(2):296–298. doi: 10.1136/ard.2004.023176 PubMedCrossRefGoogle Scholar
  53. 53.
    Blue Cross Blue Shield Association Technology Evaluation Centre (BCBS) (2003) Off label uses for tumor necrosis factor inhibitors in ankylosing spondylitis, ulcerative colitis, and psoriasis, Chicago, p 61Google Scholar
  54. 54.
    Canadian Coordinating Office for Health Technology Assessment (CCOHTA) (2004) Infliximab (Remicade TM) for the treatment of ankylosing spondylitis, Ottawa, p 54Google Scholar
  55. 55.
    Canadian Coordinating Office for Health Technology Assessment (CCOHTA) (2004) Etanercept for the treatment of ankylosing spondylitis, Ottawa, p 53Google Scholar
  56. 56.
    BSR guidelines for prescribing TNF alpha blockers in adults with ankylosing spondylitis (2004) The British Society for Rheumatology.
  57. 57.
    Barkham N, Kong KO, Tennant A et al (2005) The unmet need for anti-tumour necrosis factor (anti-TNF) therapy in ankylosing spondylitis. Rheumatology 44(10):1277–1281. doi: 10.1093/rheumatology/keh713 PubMedCrossRefGoogle Scholar
  58. 58.
    Sampaio-Barros PD, Costallat LT, Bertolo MB, Neto JF, Samara AM (2000) Methotrexate in the treatment of ankylosing spondylitis. Scand J Rheumatol 29(3):1160–1162Google Scholar
  59. 59.
    Biasi D, Carletto A, Caramaschi P, Pacor ML, Maleknia T, Bambara LM (2000) Efficacy of methotrexate in the treatment of ankylosing spondylitis: a three year open study. Clin Rheumatol 19(2):114–117. doi: 10.1007/s100670050027 PubMedCrossRefGoogle Scholar
  60. 60.
    Altan L, Bingol U, Karakoc Y, Aydiner S, Yurtkuran M (2001) Clinical investigation of methotrexate in the treatment of ankylosing spondylitis. Scand J Rheumatol 30(5):255–259. doi: 10.1080/030097401753180318 PubMedCrossRefGoogle Scholar
  61. 61.
    Roychowdhury B, Bintley-Bagot S, Bulgen DY, Thompson RN, Tunn EJ, Moots RJ (2002) Is methotrexate effective in ankylosing spondylitis? Rheumatology 41(11):1330–1332. doi: 10.1093/rheumatology/41.11.1330 PubMedCrossRefGoogle Scholar
  62. 62.
    Gonzalez-lopez L, Garcia-Gonzalez A, Vazquez-Del-Mercado M, Munoz-Valle JF, Gamez-Nava JI (2004) Efficacy of methotrexate in ankylosing spondylitis: a randomized, double blind, placebo controlled trial. J Rheumatol 31(8):1568–1574PubMedGoogle Scholar
  63. 63.
    Haibel H, Brandt HC, Song IH et al (2007) No efficacy of subcutaneous methotrexate in active ankylosing spondylitis: a 16-week open-label trial. Ann Rheum Dis 66(3):419–421. doi: 10.1136/ard.2006.054098 PubMedCrossRefGoogle Scholar
  64. 64.
    Chen J, Liu C, Lin J (2006) Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev 4:CD004524 ReviewPubMedGoogle Scholar
  65. 65.
    Feltelius N, Hallgren R (1986) Sulphasalazine in ankylosing spondylitis. Ann Rheum Dis 45(5):396–399. doi: 10.1136/ard.45.5.396 PubMedCrossRefGoogle Scholar
  66. 66.
    Nissila M, Lehtinen K, Leirisalo-Repo M, Luukkainen R, Mutru O, Yli-kerttula U (1988) Sulphasalazine in the treatment of ankylosing spondylitis. A twenty-six week, placebo-controlled trial. Arthritis Rheum 31(9):1111–1116. doi: 10.1002/art.1780310905 PubMedCrossRefGoogle Scholar
  67. 67.
    Davis MJ, Dawes PT, Beswick E, Lewin IV, Stanworth DR (1989) Sulphasalazine therapy in ankylosing spondylitis: its effect on disease activity, immunoglobulin A and the complex immunoglobulin A-alpha-1-antitrypsin. Br J Rheumatol 28(5):410–413. doi: 10.1093/rheumatology/28.5.410 PubMedCrossRefGoogle Scholar
  68. 68.
    Taylor HG, Beswick EJ, Dawes PT (1991) Sulphasalazine in ankylosing spondylitis. A radiological, clinical and laboratory assessment. Clin Rheumatol 10(1):43–48. doi: 10.1007/BF02208032 PubMedCrossRefGoogle Scholar
  69. 69.
    Kirwan J, Edwards A, Huitfeldt B, Thompson P, Currey H (1993) The course of established ankylosing spondylitis and the effects of sulphasalazine over 3 years. Br J Rheumatol 32(8):729–733. doi: 10.1093/rheumatology/32.8.729 PubMedCrossRefGoogle Scholar
  70. 70.
    Dougados M, vam der Linden S, Leirisalo-Repo M et al (1995) Sulfasalazine in the treatment of spondyloarthropathy. A randomized, multi center, double-blind, placebo-controlled study. Arthritis Rheum 38(5):618–627. doi: 10.1002/art.1780380507 PubMedCrossRefGoogle Scholar
  71. 71.
    Clegg DO, Reda DJ, Weisman MH et al (1996) Comparison of sulphasalazine and placebo in the treatment of ankylosing spondylitis. A Department of Veterans Affairs Cooperative Study. Arthritis Rheum 39(12):2004–2012. doi: 10.1002/art.1780391209 PubMedCrossRefGoogle Scholar
  72. 72.
    Clegg DO, Reda DJ, Abdellatif M (1999) Comparison of sulfazalazine and placebo for the treatment of axial and peripheral articular manifestations of the seronegative spondyloarthropathies. A Department of Veterans Affairs Cooperative Study. Arthritis Rheum 42(11):2325–2329. doi: 10.1002/1529-0131(199911)42:11<2325::AID-ANR10>3.0.CO;2-C PubMedCrossRefGoogle Scholar
  73. 73.
    Braun J, Zochling J, Baraliakos X et al (2006) Efficacy of sulphasalazine in patients with inflammatory back pain due to undifferentiated spondyloarthritis and early ankylosing spondylitis- a multicentre randomised controlled trial. Ann Rheum Dis 65(9):1147–1153. doi: 10.1136/ard.2006.052878 PubMedCrossRefGoogle Scholar
  74. 74.
    Ferraz MB, Tugwell P, Goldsmith CH, Atra E (1990) Meta analysis of sulfasalazine in ankylosing spondylitis. J Rheumatol 17(11):1482–1486PubMedGoogle Scholar
  75. 75.
    Chen J, Liu C (2006) Is sulfazalazine effective in ankylosing spondylitis? A systematic review of randomized controlled trials. J Rheumatol 33(4):722–731PubMedGoogle Scholar
  76. 76.
    Haibel H, Rudwaleit M, Braun J, Sieper J (2005) Six months open label trial of leflunamide in active ankylosing spondylitis. Ann Rheum Dis 64(1):124–126. doi: 10.1136/ard.2003.019174 PubMedCrossRefGoogle Scholar
  77. 77.
    van Denderen JC, van der Paardt M, Nurmohamed MT, de Ryck YM, Dijkmans BA, van der Horst-Bruinsma IE et al (2005) Double blind, randomised, placebo controlled study of leflunomide in the treatment of active ankylosing spondylitis. Ann Rheum Dis 64(12):1761–1764. doi: 10.1136/ard.2005.036491 PubMedCrossRefGoogle Scholar
  78. 78.
    Dougados M, Gueguen A, Nakache JP et al (1999) Ankylosing spondylitis: what is the optimum duration of a clinical study? A one year versus a 6 weeks non-steroidal anti-inflammatory drug trial. Rheumatology 38(3):235–244. doi: 10.1093/rheumatology/38.3.235 PubMedCrossRefGoogle Scholar
  79. 79.
    Dougados M, Behier JM, Jolchine I et al (2001) Efficacy of celebrex, a cyclooxygenase 2- specific inhibitor, in the treatment of ankylosing spondylitis: a six-week controlled study with comparison against placebo and against a conventional non steroidal anti inflammatory drug. Arthritis Rheum 44(1):180–185. doi: 10.1002/1529-0131(200101)44:1<180::AID-ANR24>3.0.CO;2-K PubMedCrossRefGoogle Scholar
  80. 80.
    Wanders A, Heijde D, Landewe R et al (2005) Nonsteroidal anti-inflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomised controlled trial. Arthritis Rheum 52(6):1756–1765. doi: 10.1002/art.21054 PubMedCrossRefGoogle Scholar
  81. 81.
    van der Heijde D, Baraf HS, Ramos-Remus C et al (2005) Evaluation of the efficacy of etoricoxib in ankylosing spondylitis: result of a fifty-two week, randomized, controlled study. Arthritis Rheum 52(4):1205–1215. doi: 10.1002/art.20985 PubMedCrossRefGoogle Scholar
  82. 82.
    Gossec L, van der Heijde D, Melian A et al (2005) Efficacy of cyclo-oxygenase-2 inhibition by etoricoxib and naproxen on the axial manifestations of ankylosing spondylitis in the presence of peripheral arthritis. Ann Rheum Dis 64(11):1563–1567. doi: 10.1136/ard.2004.029611 PubMedCrossRefGoogle Scholar
  83. 83.
    Sieper J, Klopsch T, Richter M et al (2008) Comparison of two different dosages of celecoxib with diclofenac for the treatment of active ankylosing spondylitis: results of a 12-week randomised, double-blind, controlled study. Ann Rheum Dis 67(3):323–329. doi: 10.1136/ard.2007.075309 PubMedCrossRefGoogle Scholar
  84. 84.
    Maksymowych WP, Jhangri GS, Leclercq S, Skeith K, Yan A, Russell AS (1998) An open study of pamidronate in the treatment of refractory ankylosing spondylitis. J Rheumatol 25(4):714–717PubMedGoogle Scholar
  85. 85.
    Maksymowych WP, Lambert R, Jhangri GS et al (2001) Clinical and radiological amelioration of refractory peripheral spondyloarthritis by pulse intravenous pamidronate therapy. J Rheumatol 28(1):144–155PubMedGoogle Scholar
  86. 86.
    Maksymowych WP, Jhangri GS, Fitzgerald AA et al (2002) A six month randomised, controlled, double- blind, dose-response comparison of Intravenous pamidronate (60 mg vs 10 mg) in the treatment of non steroidal anti-inflammatory drug refractory ankylosing spondylitis. Arthritis Rheum 46(3):766–773. doi: 10.1002/art.10139 PubMedCrossRefGoogle Scholar
  87. 87.
    Haibel H, Brandt J, Rudwaleit M, Soerensen H, Sieper J, Braun J (2003) Treatment of active ankylosing spondylitis with pamidronate. Rheumatology 42(8):1018–1020. doi: 10.1093/rheumatology/keg256 PubMedCrossRefGoogle Scholar
  88. 88.
    Grover R, Shankar S, Aneja R, Marwaha V, Gupta R, Kumar A (2006) Treatment of ankylosing spondylitis with pamidronate: an open label study. Ann Rheum Dis 65(5):688–689. doi: 10.1136/ard.2005.041392 PubMedCrossRefGoogle Scholar
  89. 89.
    Maugars Y, Mathis C, Vilon P, Prost A (1992) Corticosteriod injection of the sacroiliac joint in patients with seronegative spondyloarthropathy. Arthritis Rheum 35(5):564–568. doi: 10.1002/art.1780350512 PubMedCrossRefGoogle Scholar
  90. 90.
    Braun J, Bollow M, Seyrekbasan F et al (1996) Computed tomography guided corticosteriod injection of the sacroiliac joint in patients with spondylarthropathy with sacroilitis: clinical outcome and follow-up by dynamic magnetic resonance imaging. J Rheumatol 23(4):659–664PubMedGoogle Scholar
  91. 91.
    Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A (1996) Assessment of the efficacy of sacroiliac corticosteriod injections in spondyloarthropathies: a double-blind study. Br J Rheumatol 35(8):767–770. doi: 10.1093/rheumatology/35.8.767 PubMedCrossRefGoogle Scholar
  92. 92.
    Gunaydin I, Pereira PL, Daikeler T et al (2000) Magnetic resonance imaging guided corticosteriod injection of the sacroiliac joints in patients with therapy resistant spondyloarthropathy: a pilot study. J Rheumatol 27(2):424–428PubMedGoogle Scholar
  93. 93.
    Hanly JG, Mitchell M, MacMillan L, Mosher D, Sutton E (2000) Efficacy of sacroiliac corticosteriod injections in patients with inflammatory spondyloartropathy: results of a 6 month controlled study. J Rheumatol 27(3):719–722PubMedGoogle Scholar
  94. 94.
    Rudwaleit M, Khan MA, Sieper J (2005) The challenge of diagnosis and classification in early ankylosing spondylitis. Do we need new criteria? Arthritis Rheum 52(4):1000–1008. doi: 10.1002/art.20990 PubMedCrossRefGoogle Scholar
  95. 95.
    Kenny JB, Hughes PL, Whitehouse GH (1990) Discovertebral destruction in ankylosing spondylitis: the role of computed tomography and magnetic resonance imaging. Br J Radiol 63(750):448–455PubMedCrossRefGoogle Scholar
  96. 96.
    Jevtic V, Kos-Golja M, Rozman B, McCall I (2000) Marginal erosive discovertebral “Romanus” lesions in ankylosing spondylitis demonstrated by contrast enhanced Gd-DTPA magnetic resonance imaging. Skeletal Radiol 29(1):27–33. doi: 10.1007/s002560050005 PubMedCrossRefGoogle Scholar
  97. 97.
    Goh L, Suresh P, Gafoor A, Hughes P, Hickling P (2008) Disease activity in longstanding ankylosing spondylitis: a correlation of clinical and magnetic resonance imaging findings. Clin Rheum 27(4):449–455. doi: 10.1007/s10067-007-0726-7 CrossRefGoogle Scholar
  98. 98.
    Muche B, Bollow M, Francois RJ, Sieper J, Hamm B, Braun J (2003) Anatomic structures involved in early and late-stage sacroilitis in spondyloarthritis: a detailed analysis by contrast-enhanced magnetic resonance imaging. Arthritis Rheum 48(5):1374–1384. doi: 10.1002/art.10934 PubMedCrossRefGoogle Scholar
  99. 99.
    Bredella MA, Steinbach LS, Morgan S, Ward M, Davis JC (2006) MRI of the sacroiliac joint in patients with moderate to severe ankylosing spondylitis. AJR Am J Roentgenol 187(6):1420–1426. doi: 10.2214/AJR.05.1423 PubMedCrossRefGoogle Scholar
  100. 100.
    Maksymowych WP, Landewe R (2006) Imaging in ankylosing spondylitis. Best Pract Res Clin Rheumatol 20(3):507–519. doi: 10.1016/j.berh.2006.03.006 PubMedCrossRefGoogle Scholar
  101. 101.
    Rudwaleit M, Schwarzlose S, Hilgert ES, Listing J, Braun J, Sieper J (2008) MRI in predicting a major clinical response to anti-tumour necrosis factor treatment in ankylosing spondylitis. Ann Rheum Dis 67(9):1276–1281. doi: 10.1136/ard.2007.073098 PubMedCrossRefGoogle Scholar
  102. 102.
    van der Heijde D, Landewe R, Einstein S et al (2008) Radiographic progression of ankylosing spondylitis after up to two years of treatment with etanercept. Arthritis Rheum 58(5):1324–1331. doi: 10.1002/art.23471 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of RheumatologyMusgrove Park Hospital, Taunton and Somerset NHS TrustTauntonUK
  2. 2.Department of RheumatologyUniversity Hospitals of Leicester NHS Trust, Leicester Royal InfirmaryLeicesterUK

Personalised recommendations