TNFα-inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

Key points:

  • Treatment of ankylosing spondylitis (AS) and non-radiographic spondyloarthropathy (nr-axSpA) aims to reduce disease activity, improve quality of life and preserve patients’ functional abilities.
  • Traditional disease-modifying antirheumatic drugs (tDMARDs) have shown little evidence of efficacy in the treatment of patients with AS and nr-axSpA.
  • Tumour necrosis factor (NFα) inhibitor therapy is currently the only effective treatment in patients for whom conventional therapy with non-steroidal anti-inflammatory drugs (NSAIDs) and tDMARDs has failed.
  • New therapies (that target IL-17, IL-12/IL-23 and PDE4) seem to show more promising results than therapies targeting T-cell co-stimulation, B-cell surface antigens and IL-6, in the treatment of AS and nr-axSpA.


Spondyloarthropathy (SpA) refers to a group of rheumatic disorders — ankylosing spondylitis (AS), undifferentiated SpA, psoriatic arthritis, arthritis related to inflammatory bowel disease, reactive arthritis, a juvenile form and SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) — sharing common clinical features, extra-articular manifestations and a genetic association with the type 1 major histocompatibility complex HLA-B27. Amor et al. and the European Spondyloarthropathy Study Group (ESSG) in the 1990s and, more recently, the Assessment of SpondyloArthritis International Society (ASAS), estabilished a classification criteria that culminated in classifying two large SpA subtypes, axial (axSpA) and peripheral SpA (phSpA)
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