Recent Advances in the Pharmacotherapy of Spondyloarthropathies

Abstract

Ankylosing spondylitis (AS) and related spondyloarthropathies (SpA) are relatively common (1) chronic inflammatory rheumatic diseases of uncertain etiopathogenesis (2), frequently involving the axial skeleton, including sacroiliac joints (3). The therapeutic options for the treatment of these diseases mostly involve physiotherapy and nonsteroidal, anti-inflammatory drugs (NSAIDs) as stated in recent overviews on the subject (4–9). The newer cyclooxygenase (COX)-2 selective inhibitors celecoxib and rofecoxib provide significant symptomatic benefit, and cause less gastric ulcers, but are no more effective than established NSAIDs (10). Up to 20% of AS patients are intolerant or show lack of adequate response to NSAIDs (11). Corticosteroids are effective when injected locally or intra-articularly (12), but oral dose, unlike in rheumatoid arthritis (RA), rarely provides systemic relief in AS, an interesting difference for which the underlying pathophysiologic basis is unclear.