Recent advances in the treatment of the seronegative spondyloarthropathies.
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.
Ritchlin
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Allergy/Immunology and Rheumatology Unit, Strong Memorial Hospital/University of Rochester Medical Center, Box 695, 601 Elmwood Avenue, Rochester, NY 14642, USA. christopher_ritchlin@urmc.rochester.edu
Daikh
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BE
D002939:Ciprofloxacin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D019804:Mesalamine / Q000008:administration & dosage*; D008727:Methotrexate / Q000008:administration & dosage*; D011379:Prognosis; D000091402:Prohibitins; D016032:Randomized Controlled Trials as Topic; D012698:Serologic Tests; D012720:Severity of Illness Index; D025242:Spondylarthropathies / Q000175:diagnosis* / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
C000717331:PHB2 protein, human; D000091402:Prohibitins; D014409:Tumor Necrosis Factor-alpha; D019804:Mesalamine; D002939:Ciprofloxacin; D008727:Methotrexate