Hospital General de Granollers, Department of Medicine, Granollers, Spain.
Expert Opin Emerg Drugs. 2013 Mar;18(1):71-86. doi: 10.1517/14728214.2013.752815. Epub 2012 Dec 20.
Only non-steroidal anti-inflammatories (NSAIDs) and TNF inhibitors (TNFi) are effective in ankylosing spondylitis (AS). However, not all patients successfully respond to these drugs and a subset may have contraindications to their use.
In the last decade, an earlier diagnosis of AS has been achieved due to the increasing availability of MRI. This has led to prompt treatment initiation with improved outcomes. NSAIDs and TNFi are the current treatments for AS which lead to sustained clinical responses in the long term. Recent studies have shown other potential biomarkers in AS, such as the IL-17/IL-23 axis. This has translated into the development of new drugs which interfere with these pathways, such as apremilast and secukinumab, which have shown efficacy in early clinical trials.
AS carries considerable short- and long-term disabilities. Anti-TNF-α therapies reduce pain, improve function and decrease inflammation as seen by MRI. New treatment options are being developed which may prove efficacious on those patients not responding to anti-TNF. The ultimate research goal should focus on treatments to prevent and stop new bone formation.
非甾体类抗炎药（NSAIDs）和肿瘤坏死因子抑制剂（TNFi）仅对强直性脊柱炎（AS）有效。然而，并非所有患者对这些药物都有成功的反应，有些患者可能存在使用禁忌。
在过去十年中，由于 MRI 的广泛应用，AS 的早期诊断得以实现。这导致了及时的治疗启动，并取得了更好的效果。NSAIDs 和 TNFi 是目前治疗 AS 的方法，可在长期内实现持续的临床反应。最近的研究表明，AS 还有其他潜在的生物标志物，如 IL-17/IL-23 轴。这促使开发了新的药物来干扰这些通路，如阿普司特和司库奇尤单抗，它们在早期临床试验中显示出疗效。
AS 会导致严重的短期和长期残疾。抗 TNF-α 治疗可减轻疼痛、改善功能并减少炎症，这可通过 MRI 观察到。正在开发新的治疗选择，这些选择可能对那些对抗 TNF 治疗无反应的患者有效。最终的研究目标应集中在预防和停止新骨形成的治疗上。
