Current Rheumatology Reports

, Volume 3, Issue 5, pp 399–403

Recent advances in the treatment of the seronegative spondyloarthropathies

  • Christopher T. Ritchlin
  • Brian E. Daikh
Article

Abstract

The observation that anti-tumor necrosis factor (anti-TNF) therapies dramatically reduce joint pain and inflammation and retard radiographic progression in rheumatoid arthritis (RA) has created a considerable amount of enthusiasm among rheumatologists and has set new treatment standards for patients with inflammatory joint disease. A central question that has emerged is whether these agents are effective in treating the seronegative spondyloarthropathies (SpA). A related question is whether second-line agents such as methotrexate (MTX) can improve axial inflammation and functional measures if administered early in disease. The SpA are a cluster of inflammatory arthridites encompassing ankylosing spondylitis (AS), psoriatic arthritis (PsA), Reiter’s syndrome/reactive arthritis (ReA), and the arthritis associated with inflammatory bowel disease. These disorders share similar clinical and immunogenetic features including axial arthritis and enthesopathy, a general predilection for males and patients positive for the MHC class I alleles, the absence of rheumatoid factor, and association with infections of the intestinal and genitourinary tracts. Reclassification of SpA based on axial or peripheral involvement may be more relevant from a pathophysiologic and therapeutic perspective than the current stratification, given the strong association between axial disease and the HLAB27 allele and the relative resistance of axial disease to conventional anti-inflammatory therapy.

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Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Christopher T. Ritchlin
    • 1
  • Brian E. Daikh
    • 1
  1. 1.Allergy/Immunology and Rheumatology UnitStrong Memorial Hospital/University of Rochester Medical CenterRochesterUSA

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