Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2005 Nov;64(Suppl 4):iv61–iv64. doi: 10.1136/ard.2005.042432

How early should ankylosing spondylitis be treated with tumour necrosis factor blockers?

J Sieper, M Rudwaleit
PMCID: PMC1766918  PMID: 16239391

Abstract

Recognition and treatment of ankylosing spondylitis (AS) in the early stages of the disease has yet to be established. This paper considers the evidence available and the questions that need to be answered regarding the benefits of early diagnosis and treatment with tumour necrosis factor (TNF) blockers in AS. The authors conclude that AS can and has to be diagnosed earlier than is being done at present, before radiological changes are evident, and the potential of TNF blockers to induce long term remission if given early enough needs to be clarified.

Full Text

The Full Text of this article is available as a PDF (109.5 KB).

Figure 1.

Figure 1

Open in a new tab

 There is a continuous spectrum in patients with axial spondyloarthritis (SpA) from a pre-radiological stage to a radiological stage (classic ankylosing spondylitis) of the disease. Reproduced with permission from Rudwaleit M, Khan MA, Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? [review] Arthritis Rheum 2005;52:1000–8, New Jersey: John Wiley and Sons, Inc.

Figure 2.

Figure 2

Open in a new tab

 Patients with ankylosing spondylitis show a better response if treated with tumour necrosis factor blockers (infliximab or etanercept) early in the course their disease as judged by the percentage of patients showing a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50% improvement. Modified from Rudwaleit M, Listing J, Brandt J, Braun J, Sieper J. Prediction of a major clinical response (BASDAI 50) to tumour necrosis alpha blockers in ankylosing spondylitis. Ann Rheum Dis 2004;63:665–70.

Figure 3.

Figure 3

Open in a new tab

 (A–C) Magnetic resonance imaging (MRI) scan (STIR (short tau inversion recovery) technique) of the spine during treatment with infliximab (5 mg/kg body weight given every six weeks) showing disappearance of acute inflammation (anterior spondylitis).15

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amor B., Dougados M., Listrat V., Menkes C. J., Roux H., Benhamou C., Blotman F., Pattin S., Paolaggi J. B., Duquesnoy B. Are classification criteria for spondylarthropathy useful as diagnostic criteria? Rev Rhum Engl Ed. 1995 Jan;62(1):10–15. [PubMed] [Google Scholar]
  2. Amor B., Santos R. S., Nahal R., Listrat V., Dougados M. Predictive factors for the longterm outcome of spondyloarthropathies. J Rheumatol. 1994 Oct;21(10):1883–1887. [PubMed] [Google Scholar]
  3. Baraliakos X., Davis J., Tsuji W., Braun J. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis before and after therapy with the tumor necrosis factor alpha receptor fusion protein etanercept. Arthritis Rheum. 2005 Apr;52(4):1216–1223. doi: 10.1002/art.20977. [DOI] [PubMed] [Google Scholar]
  4. Baraliakos Xenofon, Listing Joachim, Brandt Jan, Zink Angela, Alten Rieke, Burmester Gerd, Gromnica-Ihle Erika, Kellner Herbert, Schneider Matthias, Sörensen Helmut. Clinical response to discontinuation of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab. Arthritis Res Ther. 2005 Feb 21;7(3):R439–R444. doi: 10.1186/ar1693. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Brandt J., Khariouzov A., Listing J., Haibel H., Sörensen H., Grassnickel L., Rudwaleit M., Sieper J., Braun J. Six-month results of a double-blind, placebo-controlled trial of etanercept treatment in patients with active ankylosing spondylitis. Arthritis Rheum. 2003 Jun;48(6):1667–1675. doi: 10.1002/art.11017. [DOI] [PubMed] [Google Scholar]
  6. Brandt J., Listing J., Haibel H., Sörensen H., Schwebig A., Rudwaleit M., Sieper J., Braun J. Long-term efficacy and safety of etanercept after readministration in patients with active ankylosing spondylitis. Rheumatology (Oxford) 2004 Nov 23;44(3):342–348. doi: 10.1093/rheumatology/keh475. [DOI] [PubMed] [Google Scholar]
  7. Braun J., Baraliakos X., Golder W., Brandt J., Rudwaleit M., Listing J., Bollow M., Sieper J., Van Der Heijde D. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system. Arthritis Rheum. 2003 Apr;48(4):1126–1136. doi: 10.1002/art.10883. [DOI] [PubMed] [Google Scholar]
  8. Braun J., Bollow M., Remlinger G., Eggens U., Rudwaleit M., Distler A., Sieper J. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum. 1998 Jan;41(1):58–67. doi: 10.1002/1529-0131(199801)41:1<58::AID-ART8>3.0.CO;2-G. [DOI] [PubMed] [Google Scholar]
  9. Braun J., Brandt J., Listing J., Zink A., Alten R., Golder W., Gromnica-Ihle E., Kellner H., Krause A., Schneider M. Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet. 2002 Apr 6;359(9313):1187–1193. doi: 10.1016/s0140-6736(02)08215-6. [DOI] [PubMed] [Google Scholar]
  10. Calin A., Dijkmans B. A. C., Emery P., Hakala M., Kalden J., Leirisalo-Repo M., Mola E. M., Salvarani C., Sanmartí R., Sany J. Outcomes of a multicentre randomised clinical trial of etanercept to treat ankylosing spondylitis. Ann Rheum Dis. 2004 Sep 2;63(12):1594–1600. doi: 10.1136/ard.2004.020875. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Carette S., Graham D., Little H., Rubenstein J., Rosen P. The natural disease course of ankylosing spondylitis. Arthritis Rheum. 1983 Feb;26(2):186–190. doi: 10.1002/art.1780260210. [DOI] [PubMed] [Google Scholar]
  12. Dougados M., Dijkmans B., Khan M., Maksymowych W., van der Linden Sj, Brandt J. Conventional treatments for ankylosing spondylitis. Ann Rheum Dis. 2002 Dec;61 (Suppl 3):iii40–iii50. doi: 10.1136/ard.61.suppl_3.iii40. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Feldtkeller Ernst, Khan Muhammad Asim, van der Heijde Désirée, van der Linden Sjef, Braun Jürgen. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int. 2002 Sep 3;23(2):61–66. doi: 10.1007/s00296-002-0237-4. [DOI] [PubMed] [Google Scholar]
  14. Johnsen K., Gran J. T., Dale K., Husby G. The prevalence of ankylosing spondylitis among Norwegian Samis (Lapps). J Rheumatol. 1992 Oct;19(10):1591–1594. [PubMed] [Google Scholar]
  15. Keen Helen I., Emery Paul. How should we manage early rheumatoid arthritis? From imaging to intervention. Curr Opin Rheumatol. 2005 May;17(3):280–285. doi: 10.1097/01.bor.0000160779.05389.95. [DOI] [PubMed] [Google Scholar]
  16. Klareskog Lars, van der Heijde Désirée, de Jager Julien P., Gough Andrew, Kalden Joachim, Malaise Michel, Martín Mola Emilio, Pavelka Karel, Sany Jacques, Settas Lucas. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet. 2004 Feb 28;363(9410):675–681. doi: 10.1016/S0140-6736(04)15640-7. [DOI] [PubMed] [Google Scholar]
  17. Kobelt G., Andlin-Sobocki P., Brophy S., Jönsson L., Calin A., Braun J. The burden of ankylosing spondylitis and the cost-effectiveness of treatment with infliximab (Remicade). Rheumatology (Oxford) 2004 Jun 29;43(9):1158–1166. doi: 10.1093/rheumatology/keh271. [DOI] [PubMed] [Google Scholar]
  18. Mullighan C. G., Heatley S., Lester S., Rischmueller M., Gordon T. P., Bardy P. G. Fas gene promoter polymorphisms in primary Sjögren's syndrome. Ann Rheum Dis. 2004 Jan;63(1):98–101. doi: 10.1136/ard.2003.006056. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Quinn Mark A., Conaghan Philip G., O'Connor Philip J., Karim Zunaid, Greenstein Adam, Brown Andrew, Brown Clare, Fraser Alexander, Jarret Stephen, Emery Paul. Very early treatment with infliximab in addition to methotrexate in early, poor-prognosis rheumatoid arthritis reduces magnetic resonance imaging evidence of synovitis and damage, with sustained benefit after infliximab withdrawal: results from a twelve-month randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2005 Jan;52(1):27–35. doi: 10.1002/art.20712. [DOI] [PubMed] [Google Scholar]
  20. Rudwaleit M., Listing J., Brandt J., Braun J., Sieper J. Prediction of a major clinical response (BASDAI 50) to tumour necrosis factor alpha blockers in ankylosing spondylitis. Ann Rheum Dis. 2004 Mar 22;63(6):665–670. doi: 10.1136/ard.2003.016386. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Rudwaleit M., van der Heijde D., Khan M. A., Braun J., Sieper J. How to diagnose axial spondyloarthritis early. Ann Rheum Dis. 2004 May;63(5):535–543. doi: 10.1136/ard.2003.011247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rudwaleit Martin, Khan Muhammad A., Sieper Joachim. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum. 2005 Apr;52(4):1000–1008. doi: 10.1002/art.20990. [DOI] [PubMed] [Google Scholar]
  23. Sieper J., Rudwaleit M. Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care. Ann Rheum Dis. 2004 Nov 4;64(5):659–663. doi: 10.1136/ard.2004.028753. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Wanders Astrid, Heijde Désirée van der, Landewé Robert, Béhier Jéhan-Michel, Calin Andrei, Olivieri Ignazio, Zeidler Henning, Dougados Maxime. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum. 2005 Jun;52(6):1756–1765. doi: 10.1002/art.21054. [DOI] [PubMed] [Google Scholar]
  25. van der Heijde Désirée, Dijkmans Ben, Geusens Piet, Sieper Joachim, DeWoody Kimberly, Williamson Paul, Braun Jürgen, Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy Study Group Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT). Arthritis Rheum. 2005 Feb;52(2):582–591. doi: 10.1002/art.20852. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES