title: Infliximab in the treatment of ankylosing spondylitis.
abstract: Ankylosing spondylitis (AS) is a chronic, progressive disease characterized by inflammation in the spine and sacroiliac joints which causes pain, stiffness and the potential for spinal ankylosis. It is associated with significant functional impairment. It is common and since onset is often in young people, the burden of disease is considerable. Conventional treatment including non-steroidal antiinflammatory drugs (NSAIDs) and physiotherapy have proven but limited efficacy in controlling symptoms and preventing progression of spinal manifestations. Infliximab, a chimeric monoclonal antibody which binds to and inhibits tumor necrosis factor alpha (TNFalpha), is highly effective in controlling disease activity in AS. In AS, infliximab 5 mg/kg body weight is usually given as an infusion at weeks 0, 2 and 6, and then every 6-8 weeks. When infliximab is used in combination with NSAIDs a rapid improvement in disease activity by at least 50% is seen in as many as 50% of AS patients. Infliximab has been shown to have ongoing efficacy for as long as regular infusions continue and is safe in the medium term. Magnetic resonance studies show major reductions in spinal inflammation during treatment with infliximab, however ongoing studies will assess if infliximab has disease modifying effect in AS.
authors.affiliation: Malaghan Institute of Medical Research, Wellington, New Zealand;
authors.forename: Rebecca
authors.initials: R
authors.lastname: Grainger
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Harrison
references.citation: Arthritis Rheum. 2006 Jun;54(6):1795-804
references.pmid: 16729282
references.citation: Rheumatology (Oxford). 2004 Sep;43(9):1158-66
references.pmid: 15226514
references.citation: Ann Rheum Dis. 2004 Jun;63(6):665-70
references.pmid: 15037444
references.citation: Arthritis Res Ther. 2005;7(3):R439-44
references.pmid: 15899030
references.citation: Arthritis Rheum. 2004 Aug;50(8):2622-32
references.pmid: 15334477
references.citation: Arthritis Rheum. 2002 Jan;46(1):223-31
references.pmid: 11817595
references.citation: Arthritis Rheum. 2001 Jan;44(1):186-95
references.pmid: 11212159
references.citation: Ann Rheum Dis. 2006 Mar;65(3):316-20
references.pmid: 16096329
references.citation: J Rheumatol. 2002 May;29(5):959-65
references.pmid: 12022358
references.citation: N Engl J Med. 1999 May 6;340(18):1398-405
references.pmid: 10228190
references.citation: Ann Rheum Dis. 2005 Feb;64(2):229-34
references.pmid: 15388511
references.citation: Ann Rheum Dis. 2001 Aug;60(8):750-5
references.pmid: 11454638
references.citation: Clin Exp Rheumatol. 2005 Jul-Aug;23(4):513-6
references.pmid: 16095121
references.citation: Arthritis Rheum. 2004 Sep;50(9):2942-53
references.pmid: 15457463
references.citation: J Rheumatol. 2005 Apr;32(4):721-8
references.pmid: 15801031
references.citation: Lancet. 2000 Nov 25;356(9244):1821-2
references.pmid: 11117919
references.citation: Ann Rheum Dis. 2002 Dec;61 Suppl 3:iii40-50
references.pmid: 12381510
references.citation: Arthritis Rheum. 1998 Sep;41(9):1552-63
references.pmid: 9751087
references.citation: Mol Immunol. 1993 Nov;30(16):1443-53
references.pmid: 8232330
references.citation: Ann Rheum Dis. 2002 Mar;61(3):207-12
references.pmid: 11830424
references.citation: Cytokine. 1995 Jan;7(1):15-25
references.pmid: 7538333
references.citation: J Rheumatol. 2006 Apr;33(4):732-40
references.pmid: 16583476
references.citation: Ann Rheum Dis. 2005 Nov;64(11):1568-75
references.pmid: 15829577
references.citation: Arthritis Rheum. 2001 Aug;44(8):1876-86
references.pmid: 11508441
references.citation: Cytokine. 1995 Apr;7(3):251-9
references.pmid: 7640345
references.citation: Ann Intern Med. 2002 Jun 18;136(12):896-907
references.pmid: 12069564
references.citation: N Engl J Med. 2003 Feb 13;348(7):601-8
references.pmid: 12584368
references.citation: Arthritis Rheum. 2001 Dec;44(12):2936-7
references.pmid: 11762956
references.citation: Ann Rheum Dis. 2004 May;63(5):535-43
references.pmid: 15082484
references.citation: Arthritis Rheum. 2000 Jun;43(6):1346-52
references.pmid: 10857793
references.citation: Ann Rheum Dis. 2003 Dec;62(12):1218-20
references.pmid: 14644863
references.citation: Ann Rheum Dis. 2005 Apr;64(4):529-36
references.pmid: 15388510
references.citation: Rheumatology (Oxford). 2005 May;44(5):670-6
references.pmid: 15757965
references.citation: Arthritis Rheum. 1995 Apr;38(4):499-505
references.pmid: 7718003
references.citation: Arthritis Rheum. 1984 Apr;27(4):361-8
references.pmid: 6231933
references.citation: Rheumatology (Oxford). 1999 Nov;38(11):1058-67
references.pmid: 10556256
references.citation: Lancet. 2002 Apr 6;359(9313):1187-93
references.pmid: 11955536
references.citation: Ann Rheum Dis. 2006 Sep;65(9):1147-53
references.pmid: 16606646
references.citation: Arthritis Rheum. 2005 Feb;52(2):582-91
references.pmid: 15692973
references.citation: Arthritis Rheum. 2006 May;54(5):1646-52
references.pmid: 16646033
references.citation: Lancet. 2005 Oct 15-21;366(9494):1367-74
references.pmid: 16226614
references.citation: Rheumatology (Oxford). 2002 Nov;41(11):1280-5
references.pmid: 12422001
references.citation: Br J Rheumatol. 1994 Oct;33(10):927-31
references.pmid: 7921752
references.citation: Ann Rheum Dis. 2000 Jun;59(6):428-33
references.pmid: 10834859
references.citation: J Rheumatol Suppl. 2006 Sep;78:4-11
references.pmid: 17042055
references.citation: Ann Rheum Dis. 2005 Oct;64(10):1462-6
references.pmid: 15778240
references.citation: Arthritis Rheum. 2002 Mar;46(3):840-1, author reply 841-3
references.pmid: 11920423
references.citation: Arthritis Rheum. 2002 Mar;46(3):755-65
references.pmid: 11920412
references.citation: N Engl J Med. 2001 Oct 11;345(15):1098-104
references.pmid: 11596589
references.citation: Ann Rheum Dis. 2003 Sep;62(9):829-34
references.pmid: 12922954
references.citation: Br J Rheumatol. 1997 Jan;36(1):38-42
references.pmid: 9117172
references.citation: Arthritis Rheum. 2000 Nov;43(11):2383-90
references.pmid: 11083258
references.citation: Arthritis Rheum. 2006 Aug 15;55(4):569-74
references.pmid: 16874778
references.citation: J Rheumatol. 2001 Jul;28(7):1605-14
references.pmid: 11469469
references.citation: Ann Rheum Dis. 2003 Sep;62(9):817-24
references.pmid: 12922952
references.citation: Ann Rheum Dis. 2004 Dec;63(12):1670-2
references.pmid: 15547093
references.citation: Arthritis Rheum. 2005 Aug;52(8):2447-51
references.pmid: 16052578
references.citation: Rheumatol Int. 1994;13(5):175-80
references.pmid: 8202660
references.citation: Lancet. 1999 Dec 4;354(9194):1932-9
references.pmid: 10622295
references.citation: Arthritis Rheum. 2003 Apr;48(4):1126-36
references.pmid: 12687557
references.citation: J Rheumatol. 1996 Nov;23(11):1849-55
references.pmid: 8923355
references.citation: Ann Rheum Dis. 2006 Apr;65(4):423-32
references.pmid: 16126792
references.citation: Ann Rheum Dis. 2003 Apr;62(4):347-9
references.pmid: 12634235
references.citation: Nat Immunol. 2001 Sep;2(9):771-3
references.pmid: 11526382
references.citation: N Engl J Med. 2000 Nov 30;343(22):1594-602
references.pmid: 11096166