Non steroidal antiinflammatory drugs (NSAID) used to be the only drugs active in ankylosing spondylarthritis (AS). However, they are inadequate or ill-tolerated in many patients, and have no proven impact on disease-related structural changes. Clinical trials have recently shown the impressive efficacy of two anti-TNFalpha agents (infliximab and etanercept) in patients with NSAID-resistant SA. These drugs attenuate inflammatory pain, stiffness and functional disability, and improve mobility and quality of life. Tolerability is satisfactory, and efficacy persists during several years of treatment. Moreover, these agents induce regression of acute inflammatory lesions, as demonstrated by magnetic resonance imaging (MRI). A 2-year X-ray study indicates that they also slow the progression of structural lesions. More studies are needed to determine the precise place of anti-TNFalpha agents in this setting.
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