Tumor necrosis factor-alpha blockade in ankylosing spondylitis: a potent but expensive anti-inflammatory treatment or true disease modification?

Blocking tumor necrosis factor-alpha either with monoclonal antibodies or with soluble receptor constructs has been proven to be effective with an acceptable safety profile in patients with rheumatoid arthritis, and more recently also in the diseases belonging to the spondyloarthropathy concept. Nevertheless multiple questions still remain unresolved especially concerning longer-term treatment. Data from a recent manuscript by Baraliakos and colleagues seem to indicate that at least for the vast majority of ankylosing spondylitis patients treatment with infliximab can not be withdrawn, if one wants to control disease activity in a continuous way. Although still unproven, this might be of crucial importance with regard to structure modification and prevention of ankylosis in this chronic inflammatory disorder.