TNFα-inhibitors for ankylosing spondylitis and nonradiographic axial spondyloarthritis

Spondyloarthropathy refers to a group of articular inflammatory diseases that share common genetic, clinical and radiological features in addition to their association with human leucocyte antigen (HLA)-B27 antigen. The aim of therapeutic management of patients with spondyloarthritis is to improve quality of life, control the symptoms of articular inflammation, prevent the structural damage of joints, and preserve the functional abilities, autonomy and social participation of patients. Although disease-modifying anti-rheumatic drugs demonstrate some benefit in the treatment of peripheral arthritis, they have shown to be ineffective for the treatment of patients with axial disease. Biological therapies and new imaging techniques have changed the therapeutic and diagnostic approach to spondyloarthritis. In patients with axial spondyloarthritis for whom conventional therapy with non-steroidal anti-inflammatory drugs has failed, TNFα-inhibitor treatment is currently the only effective therapy. It is more effective in preventing articular damage in peripheral joints compared with joints of the spine. The aim of this review is to summarise the current evidence for treating ankylosing spondylitis and non-radiographic axial spondyloarthritis with TNFα-inhibitor.