Current use of biologicals for the treatment of spondyloarthropathies.
Spondyloarthropathies (SpA) are a group of related disorders. The hallmark symptoms include spondylitis, pauci-articular synovitis and enthesiopathy. In an important number of cases, subclinical gut inflammation with pathological findings resembling Crohn's disease can be found. Some of these patients may eventually develop overt Crohn's disease. Conventional medical therapy in patients with SpA consists of non-steroidal anti-inflammatory drugs (NSAIDs). Sulphasalazin can be co-administered, especially in cases of chronic synovitis or enthesiopathy. Recently, experience with anti-TNF-alpha monoclonal antibodies (infliximab), a new class of biological compounds, has opened new avenues for treating patients with SpA. In particular, infliximab used in two open studies gave significant benefit on the locomotor manifestations in patients with Crohn's disease, in patients with ankylosing spondylitis, undifferentiated SpA and psoriatic arthritis. Etanercept, another TNF-alpha antagonist (soluble receptor), was shown to induce benefit in a placebo-controlled study in patients with psoriatic arthritis. The relationship between SpA and inflammatory bowel disease lead to the hypothesis that interfering with gut inflammation in patients with SpA would yield a potential target for modulating the synovitis in these patients. Thus, besides TNF-alpha blockade, other strategies with potential efficacy can be envisioned, such as IL-10, ICAM-1 antisense or anti-(4)beta(7) antibodies.
Keyser
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FD
Department of Rheumatology, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium. filip.dekeyser@rug.ac.be
Mielants
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H
Veys
E M
EM
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000942:Antigens, Bacterial / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D016753:Interleukin-10 / Q000627:therapeutic use; D020319:Oligodeoxyribonucleotides, Antisense / Q000627:therapeutic use; D054735:Phosphorothioate Oligonucleotides; D025242:Spondylarthropathies / Q000188:drug therapy* / Q000276:immunology; D013873:Thionucleotides / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000276:Adjuvants, Immunologic; D000911:Antibodies, Monoclonal; D000942:Antigens, Bacterial; D018501:Antirheumatic Agents; D020319:Oligodeoxyribonucleotides, Antisense; D054735:Phosphorothioate Oligonucleotides; D013873:Thionucleotides; D014409:Tumor Necrosis Factor-alpha; C050501:OM 89; D016753:Interleukin-10; D000069285:Infliximab; C089753:alicaforsen