Skip to main content
SpringerLink
Log in

Management of Spondyloarthropathy

New Pharmacological Treatment Options

  • Leading Article
  • Published:
Drugs Aims and scope Submit manuscript

Abstract

Spondyloarthropathies (SpA) are a group of inflammatory arthritides classified according to common features of peripheral and spinal arthritis. The conventional anti-inflammatory and disease-modifying or slow-acting anti-rheumatic drugs do appear to be efficacious in treatment of the peripheral arthritis in a comparable fashion to seropositive rheumatoid arthritis, however, their efficacy in axial disease is unproven. This review examines new pharmacological developments in the treatment of SpA including the specific features of sacroiliitis, enthesitis and spondylitis in addition to the peripheral manifestations. The main points that are discussed are new cyclo-oxygenase (COX)-2 specific anti-inflammatories, biological therapies, such as anti-TNF compounds, and novel uses of well-known agents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Fig. 1

Similar content being viewed by others

References

  1. Benson WG, Fiechtner JJ, McMillen JI, et al. Treatment of osteoarthritis with celecoxib, a cyclooxygenase-2 inhibitor: a randomized controlled trial. Mayo Clin Proc 1999; 74: 1095–105

    Article  Google Scholar 

  2. Simon LS, Weaver AL, Graham DY, et al. Anti-inflammatory and upper gastrointestinal effects of celecoxib in rheumatoid arthritis: a randomized controlled trial. JAMA 1999; 282: 1921–8

    Article  PubMed  CAS  Google Scholar 

  3. Emery P, Zeidler H, Kvien TK, et al. Celecoxib versus Diclofenac in long-term management of rheumatoid arthritis: randomized double-blind comparison. Lancet 1999; 354: 2106–11

    Article  PubMed  CAS  Google Scholar 

  4. Dougados M, Behier JM, Jolchine I, et al. Efficacy of celecoxib, a cyclooxygenase 2-specific inhibitor, in the treatment of Ankylosing Spondylitis. Arthritis Rheum 2001; 44(1): 180–5

    Article  PubMed  CAS  Google Scholar 

  5. Dougados M, Gueguen A, Nakache JP at el. Ankylosing Spondylitis: what is the optimum duration of a clinical study?. A one-year versus a six-weeks NSAID drug trial. Br J Rheumatol 1999; 38: 235–44

    CAS  Google Scholar 

  6. Maugars Y, Matthias C, Vilon P, et al. Corticosteroid injection of the sacroiliac joints in patients with seronegative spondyloarthropathy. Arthritis Rheum 1992; 35: 564–8

    Article  PubMed  CAS  Google Scholar 

  7. Maugars Y, Matthias C, Berthelot J, et al. Assessment of the efficacy of sacroiliac corticosteroid injection in Spondyloarthropathy: a double-blind study. Br J Rheumatol 1996; 35: 767–70

    Article  PubMed  CAS  Google Scholar 

  8. Gunaydin I, Pereira PL, Daikeles T, et al. MRI guided corticosteroid injection of the sacroiliac joints in patients with therapy resistant spondyloarthropathy: a pilot study. J Rheumatol 2000; 27: 424–8

    PubMed  CAS  Google Scholar 

  9. Moreland LW, Baumgartner SW, Schiff MH, et al. Treatment of rheumatoid arthritis with a recombinant human TNF receptor (p75)-Fc fusion protein. N Eng J Med 1997; 337: 141–8

    Article  CAS  Google Scholar 

  10. Maini R, St. Clair EW, Breedveld F, et al. Infliximab (chimeric anti-TNF alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomized phase 3 trial. ATTRACT study gp. Lancet 1999; 354: 1932–9

    Article  PubMed  CAS  Google Scholar 

  11. Sandborn WJ, et al. Anti-tumour necrosis factor therapy for inflammatory bowel disease: a review of agents, pharmacology, clinical results and safety. Inflamm Bowel Dis 1999; 5: 119–33

    Article  PubMed  CAS  Google Scholar 

  12. Van den Bosch F, Kruithof E, Baeten D, et al. Effects of a loading dose regime of 3 infusions of chimeric monoclonal antibody to TNF alpha (infliximab) in spondyloarthropathy: an open pilot study. Ann Rheum Dis 2000; 59: 428–33

    Article  PubMed  Google Scholar 

  13. Kruithof E, Van den Bosch F, Baeten D, et al. Repeated infusions of infliximab, a chimeric anti-TNFα monoclonal antibody, in patients with active spondyloarthropathy: one year follow up. Ann Rheum Dis 2002; 61: 207–12

    Article  PubMed  CAS  Google Scholar 

  14. Baeten D, Kruithof E, Van den Bosch F, et al. Immunomodulatory effects of Anti-TNF-a therapy on synovium in spondyloarthropathy. Arthritis Rheum 2001; 44: 186–95

    Article  PubMed  CAS  Google Scholar 

  15. Van den Bosch F, Kruithof E, De Vos M, et al. Crohn’s disease associated with spondyloarthropathy: effect of TNF alpha blockade (infliximab) on the articular symptoms. Lancet 2000b; 356: 1821–2

    Article  Google Scholar 

  16. Brandt J, Haibel H, Reddig J, et al. Successful short term treatment of severe undifferentiated spondyloarthropathy with the anti-tumour necrosis factor-α monoclonal antibody infliximab. J Rheumatol 2002; 29: 118–22

    PubMed  CAS  Google Scholar 

  17. Brandt J, Haibel H, Cornely D, et al. Successive treatment of active ankylosing spondylitis with the anti-tumour necrosis factor alpha monoclonal antibody infliximab. Arthritis Rheum 2000; 43: 1346–52

    Article  PubMed  CAS  Google Scholar 

  18. Mease PJ, Goffe BS, Metz J, et al. Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomized trial. Lancet 2000; 356: 385–90

    Article  PubMed  CAS  Google Scholar 

  19. Stone M, Salonen D, Lax M, et al. Clinical and imaging correlates of response to treatment with infliximab in patients with Ankylosing Spondylitis. J Rheumatol 2001; 28: 1605–14

    PubMed  CAS  Google Scholar 

  20. Marzo-Ortega H, McGonagle D, O’Connor P, et al. Efficacy of Etanercept in the treatment of the entheseal pathology in resistant spondyloarthropathy. Arthritis Rheum 2001; 44: 2112–7

    Article  PubMed  CAS  Google Scholar 

  21. Dougados M, Maetzel A, Mijiyawa M, et al. Evaluation of sulphasalazine in the treatment of spondyloarthropathies. Ann Rheum Dis 1992; 51: 955–8

    Article  PubMed  CAS  Google Scholar 

  22. Dougados M, Van der Linden S, Leirisalo-Repo M, et al. Sulfasalazine in the treatment of spondyloarthropathy. A randomized, multimember, double blind, placebo-controlled study. Arthritis Rheum 1995; 38: 618–27

    CAS  Google Scholar 

  23. Thomson GTD, Thomson BRJ, Thomson KS, et al. Clinical efficacy of mesalamine in the treatment of the spondyloarthropathies. J Rheumatol 2000; 27: 714–8

    PubMed  CAS  Google Scholar 

  24. Dekker-saeys BJ, Dijkmans BAC, Tytgat GNJ. Treatment of spondyloarthropathy with 5-Aminosalicylic Acid (Mesalazine): an open trial. J Rheumatol 2000; 27(3): 723–6

    PubMed  CAS  Google Scholar 

  25. Kinne RW, Schmidt CB, Buchner E, et al. Treatment of rat arthritides with clodronate-containing liposomes. Scand J Rheumatol 1995; 24: 91–7

    Article  Google Scholar 

  26. Eggelmeijer F, Papapoulos SE, Van Paassen HC, et al. Clinical and biochemical response to single infusion of pamidronate in patients with active rheumatoid arthritis: a double blind placebo controlled study. J Rheumatol 1994; 21: 2016–20

    PubMed  CAS  Google Scholar 

  27. Maccagno A, DiGiorgio E, Roldan EJA, et al. Double blind radiological assessment of continuous oral pamidronic acid in patients with rheumatoid arthritis. Scand J Rheumatol 1994; 23: 211–4

    Article  PubMed  CAS  Google Scholar 

  28. Ralston SH, Hackling L, Willocks L, et al. Clinical, biochemical and radiographic effects of aminohydroxypropylidene biphosphonate treatment in rheumatoid arthritis. Ann Rheum Dis 1989; 48: 396–9

    Article  PubMed  CAS  Google Scholar 

  29. Maksymowych WP, Lambert R, Jhangri GS, et al. Clinical and radiological amelioration of refractory peripheral spondyloarthritis by pulse intravenous pamidronate therapy. J Rheumatol 2001 Jan; 28(1): 144–55

    PubMed  CAS  Google Scholar 

  30. Klausner JD, Freedman VH, Kaplan G. Thalidomide as an anti TNF alpha inhibitor: implications of clinical use. Clin Immunol Immunopathol 1996; 81: 218–23

    Article  Google Scholar 

  31. Breban M, Grombert B, Amore B, et al. Efficacy of thalidomide in the treatment of refractory Ankylosing Spondylitis. Arthritis Rheum 1999; 42: 580–1

    Article  PubMed  CAS  Google Scholar 

  32. Fryden A, Bengtsson A, Foberg U, et al. Early antibiotic treatment of reactive arthritis associated with enteric infections: clinical and serological study. BMJ 1990; 301: 1299–302

    Article  PubMed  CAS  Google Scholar 

  33. Lauhio A, Leirisalo-Repo M, Lahdevirta J, et al. Double-blind, placebo-controlled study of three-month treatment with lymecycline in reactive arthritis, with special reference to Chlamydia arthritis. Arthritis Rheum 1991; 34: 6–14

    Article  PubMed  CAS  Google Scholar 

  34. Kihlstrom E, Foberg U, Bengtsson A, et al. Intestinal symptoms and serological response in patients with complicated and uncomplicated Yersinia enterocolotica infections. Scand J Infect Dis 1992; 24: 57–63

    Article  PubMed  CAS  Google Scholar 

  35. Toivanen A, Yli-Kerttula T, Luukkainen R, et al. Effect of antimicrobial treatment on chronic reactive arthritis. Clin Exp Rheumatol 1993; 11: 301–7

    PubMed  CAS  Google Scholar 

  36. Barry AL, Jones RN, Thornsberry C, et al. Antibacterial activities of ciprofloxacin, norfloxacin, oxolinic acid, cinoxacin and nalidixic acid. Antimicrob Agents Chemother 1984; 25: 633–7

    Article  PubMed  CAS  Google Scholar 

  37. Yli-Kerttula T, Luukkainen R, Yli-Kerttula U, et al. Effect of a three month course of ciprofloxacin on the outcome of reactive arthritis. Ann Rheum Dis 2000; 59: 565–70

    Article  PubMed  CAS  Google Scholar 

  38. Smieja M, MacPherson DW, Kean W, et al. Randomised, blinded, placebo controlled trial of doxycycline for chronic seronegative arthritis. Ann Rheum Dis 2001; 60: 1088–94

    Article  PubMed  CAS  Google Scholar 

  39. Keane J, Gershon S, Wise RP, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med 2001; 345: 1098–104

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

Author information

Authors and Affiliations

  1. Department of Rheumatology, St Vincent’s University Hospital, Elm Park, Dublin, 4, Ireland

    Ruth Z. Lee &  Douglas J. Veale

Authors
  1. Ruth Z. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Douglas J. Veale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Douglas J. Veale.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, R.Z., Veale, D.J. Management of Spondyloarthropathy. Drugs 62, 2349–2359 (2002). https://doi.org/10.2165/00003495-200262160-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-200262160-00003

Keywords

Search

Navigation