title: Should we consider tumor necrosis factor as the only target in spondyloarthritides?
abstract: Understanding the biology of inflammation occurring at the entheseal-bone insertion has led to a better knowledge of the main drivers of inflammation in spondyloarthropathies. The clinical efficacy of tumor necrosis factor-α (TNF-α) blockers strongly supports the idea that TNF-α is a key molecule. Yet 40% of patients do not respond appropriately, indicating that other pathways are likely involved in these illnesses. Targeting T cells through a blockade of costimulating (CD28) molecules does not help, and in experimental models of sacroiliitis, targeting interleukin 6 (IL-6) did not provide any useful evidence. Immunohistological and functional data suggest that B cells, Th17, or IL-17A might be important, and indeed preliminary data concerning drugs targeting B cells and IL-17A seem to suggest clinical benefits.
authors: Institute of Rheumatology, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy. gf.ferraccioli@rm.unicatt.it
authors: Gianfranco
authors: G
authors: Ferraccioli
authors: Elisa
authors: E
authors: Gremese
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D001842:Bone and Bones / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D015195:Drug Design; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D007596:Joints / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D058990:Molecular Targeted Therapy; D015398:Signal Transduction / Q000187:drug effects; D025242:Spondylarthropathies / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D058504:Th17 Cells / Q000187:drug effects / Q000276:immunology; D053773:Transforming Growth Factor beta1 / Q000037:antagonists & inhibitors / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism; D000093242:Interleukin-6 Inhibitors
chemical_list: D000893:Anti-Inflammatory Agents; D015850:Interleukin-6; D053773:Transforming Growth Factor beta1; D014409:Tumor Necrosis Factor-alpha; D000093242:Interleukin-6 Inhibitors