Ankylosing Spondylitis – more myths

Today we’re going to discuss to further myths:
healing ankylosing spondylitis is around the corner
in ankylosing spondylitis nothing works.
Though considering before and after establishing TNF-alpha-inhibitors as an effective therapy is important, myths have a tendency to survive.
Before TNF-blockers therapeutic options for ankylosing spondylitis were limited to nonsteroidal antirheumatic drugs (NSAIDs) and physical therapy. Corticosteroids and disease-modifying antirheumatic drugs weren’t successful in ankylosing spondylitis. But even then, a high percetage of patients did well on NSAIDs and fighted ankylosis, stiffness, and deformations with physical therapy. It has been shown, that continuous NSAID-intake even delays radiographic progression. But there were patients (and there still are!) with ankylosing spondylitis not respoding to NSAID therapy! About 10-12 years ago TNF-blockers showed effectiveness in lots of patients, who were desperate while on NSAIDs. Or who couldn’t take NSAIDs because of adverse events. Today infliximab, etanercept, adalimumab, and golimumab are approved for the treatment of ankylosing spondylitis.
Diagnosis can be made earlier. We have an interest nowadays to diagnose the disease before radiographic changes appear. Therefore the New York criteria are a bit outdated. If you make the diagnosis with the help of this tool, it is already ankylosing spondylitis you see, whereas in axial spondyloarthritis you diagnose the inflammatory disease before radiographic damage begins to show. The question is: does early and more aggressive treatment with TNF-blockers show better responses? To cut the story short: early treatment with TNF-blockers in preradiographic axial Sponyloarthritis show a better clinical response and a higher rate of remission. Longer phases of sustained drugfree remission have been seen. But still you can’t call it healing ankylosing spondylitis. And please don’t forget that there are non-responders.
Even if healing ankylosing spondylitis isn’t around the corner, established therapies can improve quality of life in a large percentage of people with ankylosing spondylitis / axial spondyloarthropathies.

To be continued …