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Rheumatology Advance Access originally published online on August 24, 2004
Rheumatology 2005 44(1):17-23; doi:10.1093/rheumatology/keh358
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Rheumatology Vol. 44 No. 1 © British Society for Rheumatology 2004; all rights reserved

REVIEW

Assessment of patients with spondyloarthropathies for treatment with tumour necrosis factor {alpha} blockade

S. Paul1 and A. Keat

Department of Rheumatology, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ, UK.1 Present address: Department of Rheumatology, St Thomas' Hospital, London SE1 7EH, UK

Correspondence to: A. Keat. E-mail: andrew.keat@nwlh.nhs.uk

The first 150 words of the full text of this article appear below.


   Introduction
 
There is no doubt that the arrival and licensing of two tumour necrosis factor (TNF)-blocking drugs—infliximab and etanercept—for the treatment of ankylosing spondylitis (AS) represents the first major advance in the treatment of this condition since the advocacy of exercises and the introduction of phenylbutazone. These agents have also been shown unequivocally to be effective in a proportion of patients with psoriatic arthritis (PsA), comparable to their effect in rheumatoid arthritis (RA), and anecdotal reports also suggest benefits for patients with enteropathic arthritis, persistent reactive arthritis (ReA) and undifferentiated spondyloarthropathy (SpA). But, as with RA, the availability of these agents places a huge responsibility upon rheumatologists, individually and collectively, to negotiate the poorly charted waters of assessment of disease outcomes, known and potential drug toxicity and potentially massive cost. Moreover, all parties to the negotiation are signed up to the provision of such treatment according to criteria that are wise, . . . [Full Text of this Article]


   Rationale for targeting TNF-{alpha} in spondyloarthropathy
 

   Current anti TNF-{alpha} agents: infliximab, etanercept and adalimumab
 

   Outcomes of treatment of SpA and their assessment
 

   Efficacy of anti-TNF-{alpha} therapy ankylosing spondylitis
 
Infliximab
Etanercept

   Efficacy of anti-TNF-{alpha} therapy in PsA
 

   Efficacy of anti-TNF-{alpha} therapy in undifferentiated SpA (uSpA), ReA, enteropathic arthropathy and uveitis
 

   Practical considerations in the initiation of anti-TNF agents in SpA
 
Who should prescribe?
Which patients should be treated?
Which patients should not be treated?
What regimes and for how long?
How do we know if the treatment has been adequately effective?
Where now?

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N. Barkham, K. O. Kong, A. Tennant, A. Fraser, E. Hensor, A. M. Keenan, and P. Emery
The unmet need for anti-tumour necrosis factor (anti-TNF) therapy in ankylosing spondylitis
Rheumatology, October 1, 2005; 44(10): 1277 - 1281.
[Abstract] [Full Text] [PDF]