Spondyloarthritides evolving therapies 英文参考文献.docVIP

Barr and Keat Arthritis Research Therapy 2010,12:221 /content/12/6/221 RE VIE W Spondyloarthritides: evolving therapies Andrew Barr* and Andrew Keat classic radiographic change, is a continuum from a pre- Abstract radiographic phase to a radiographic phase – the whole continuum being appropriately referred to as Axial SpA [1]. During the radiographic phase, skeletal lesions are probably irreversible and may progress independently of ongoing in? ammation; conversely, the opportunities for prevention or reduction of skeletal damage may be found during the pre-radiographic phase, although recog nition of disease at this time is problematic. At this early stage, acute in? ammatory lesions may be wide spread and ? uctuating throughout the spine [2,3]; the transformation of these acute lesions to more chronic fatty bone and entheseal lesions may be what promotes the formation of new bone and hence ankylosis. It is therefore likely that treatment of spinal in? ammation and symptoms may come to be divorced from therapeutic prevention of skeletal damage. TNF blockade therapy has substantially advanced the treatment of peripheral spondyloarthritides but revolutionised the treatment of severe ankylosing spondylitis. The capacity of biologic treatment to improve dramatically symptoms and quality of life in patients with spinal disease is undoubted, although important questions remain. Notable amongst these are concerns about skeletal disease modi?cation and the true balance between costs and e?ectiveness. Guidelines for the biologic treatment of ankylosing spondylitis and psoriatic arthritis have been introduced in North America and Europe with considerable consensus. However, the absence of clear criteria for the diagnosis of early disease leaves the issue of biologic treatment of ankylosing spondylitis at the pre- radiographic stage unresolved. Newer biologic agents are entering the ?eld, although superiority over