Rheumatology: Current Research
Open Access
ISSN: 2161-1149 (Printed)
ISSN: 2161-1149 (Printed)
Subramanian Nallasivan
Velammal Medical College Hospital and Research Institute, India
Posters & Accepted Abstracts: Rheumatology (Sunnyvale)
Ankylosing spondylitis is an inflammatory disease that affects the spine predominantly and also the peripheral joints. It affects more often men than women and three times more common among Caucasians than African Americans. Characteristic symptoms are low back pain with prolonged early morning stiffness that improves with exercise. X-rays, MRI spine and sacroiliac joints and HLA B27 along with CRP and ESR would help in the diagnosis of patients with suspected spondyloarthritis. It is less likely to ankylose nowadays, with newer drugs in the therapeutic armamentarium. It is part of large spectrum of seronegative arthritis and also includes colitis related arthritis, reactive arthritis etc. The development of the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for both axial and peripheral SpA or ESSG criteria or The New York criteria all have been the welcome advancement in early diagnosis. A common treatment regimen for all the spondyloarthropathies (ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and enteropathic arthritis) involves medication, exercise and good posture practices. With the advent of TNF alpha inhibitors, management of spondyloarthritis has been revolutionized. TNF-�?± inhibitors can induce remission and prevent both clinical and radiological disease progression in AS with significant improvement in patients' symptoms, function and quality of life and long-term follow-up studies showed durable clinical efficacy. Recent Cochrane review found Researchers looked at trials done up to June 2014 (2i trials with 3308 participants) on the effect of anti-TNF drugs (adalimumab (Humira�?®), etanercept (Enbrel�?®), golimumab (Simponi�?®) and infliximab (Remicade�?®)) on ankylosing spondylitis. (Maxwell LG et al Cochrane review group). In developing countries, biosimilars have been developed and their efficacy is similar to innovator molecules and the cost of the treatment has reduced to affordable levels. The FDA Arthritis Advisory Committee has recommended the approval of CT-P13 (Remsima), a biosimilar version of the TNF inhibitor infliximab (Remicade), for ankylosing spondylitis, Crohnâ�?�?s disease and ulcerative colitis. My own patientâ�?�?s review (last 1 year) showed 8/11 patients responded very well to the biologic drug Adalimumab being marketed as Exemptia as Biosimilar and Enbrel marketed as Intacept (biosimilar). BASDAI and BASFI showed significant improvement and some of the patients as young as 16 yrs old have regained normal life.
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