The "Knowns" and "Unknowns" of Biologic Therapy in Ankylosing Spondylitis
Since the first biologic agent was tested in the treatment of ankylosing spondylitis (AS), the ability of these therapies to dramatically improve the clinical symptoms and signs of the disease was very evident. Over the past decade, 4 tumor necrosis factor-alpha inhibitors have been approved by the Food and Drug Administration for the treatment of AS. Published data include randomized controlled trials, registries and observational studies. Guidelines have also been developed for the use of biologics in AS. Although a lot is known about the use of biologics in the AS, several "unknowns" remain. Whether these agents can alter the natural history of AS if started very early in the course or whether they can prevent extra-articular manifestations are among the important unanswered questions. Most of the data summarized in this review relate to tumor necrosis factor-alpha inhibitors, and other biologic agents that have been studied are included, as well. This review also summarizes what questions remain about the use of biologics in AS and what type of studies will be required to answer them.
Available from: Shandor Erdes
[Show abstract] [Hide abstract]
ABSTRACT: The brain, spinal cord, cranial nerves, and spinal roots share an intimate anatomic relationship to the spine and skull; as a result, disorders of the skeletal system may result in neurologic compromise. This chapter reviews the neurologic complications of degenerative disease of the spine, including cervical spondylosis and disc disease, lumbar disc disease, and lumbar spinal stenosis. Neurologic consequences of disorders of bone formation and resorption are described including osteoporosis, osteomalacia, osteopetrosis, and Paget disease of bone, as well as the neurologic complications of vertebral osteomyelitis and rheumatologic diseases not covered elsewhere, such as ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, and relapsing polychondritis.
[Show abstract] [Hide abstract]
ABSTRACT: Nonsteroidal anti-inflammatory drugs (NSAIDs) are extensively used in the treatment of rheumatic diseases to relieve pain and signs of inflammation. However, when treated for ankylosing spondylosis (AS), NSAIDS exert both symptomatic and structure-modifying effects, by slowing down the development of vertebral ankylosis. The effect of these drugs, which underlines the formation of syndesmophytes, may be associated with their anti-inflammatory activity and ability to suppress abnormal bone proliferation. There is convincing evidence to support the capacity of NSAIDs, when long and continuously used, to reduce the rates of X-ray progression of AS. So the continuous use of NSAIDs must be now considered to be a mandatory component of pharmacotherapy for this disease. Their use should be continued even after achieving a marked clinical improvement. At the same time, this situation requires that the development of adverse reactions as structural and functional diseases of the gastrointestinal tract and cardiovascular system be thoroughly controlled in this situation. The danger of these complications determines the need for a physician's attention, obligatory consideration of risk factors, and rational choice of the safest NSAIDs.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.