Management of ankylosing spondylitis: What is known; What is not known?

摘要

The last few years have witnessed remarkable progress in our understanding of the natural history, pathophysiology and, finally, several aspects of the management of ankylosing spondylitis (AS) and the associated spondyloarthritis. Included among notable advances in this field are the recent development and validation of classification criteria for "axial spondyloarthritis" and "peripheral spondyloarthritis,"1'2 potentially allowing earlier diagnosis for the so-called nonra-diographic forms of the disease, the development and validation of a new disease activity scale (Ankylosing Spondylitis Disease Activity Score)3; recognition of key mediators of molecular regulation of bone formation and resorption in AS (eg, DKK-1, sclerostin and Wnt proteins)4; and potential targets for therapy [interleukin (IL)-6, IL-17, IL-12 and IL-23, among others] as well as identification of several new genes associations (eg, IL-23R and ERAP1) linked to AS.5 In the United States, approved therapies now include a fourth anti-tumor necrosis factor (TNF) agent (Go-limumab) to treat AS.