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What Alternative Therapies are there for Patients with Spondyloarthritis Refractory to TNF-α Blockers?

Fernando Kemta Lekpa, MD1, and Pascal Claudepierre, MD2

Spondyloarthritis (SpA) is a family of inflammatory rheumatic diseases that includes ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis, arthritis associated with inflammatory bowel disease, some forms of juvenile arthritis, and undifferentiated SpA [1]. The first-line treatment of these conditions, particularly AS, is still based on the optimal use of non-steroidal anti-inflammatory drugs (NSAIDs) combined with effective physiotherapy and a healthy lifestyle. When this conventional strategy fails, biological drugs may be considered either immediately in patients with axial forms of the disease, or after failure of disease-modifying antirheumatic drugs (DMARDs) with or without intra-articular corticosteroid injections in patients with peripheral forms of the disease [2,3]. Tumor necrosis factor-α (TNF-α) blockers are currently the only biological agents approved for the treatment of SpA, and their introduction has revolutionized the management of patients with this condition [2,3]. The TNF-α blockers currently used are associated with reductions in pain and acute-phase reactant levels, as well as improved function and quality of life (QoL) in the majority of patients [3]. In those with PsA, TNF-α blockers can lead to reduced progression of radiographic damage [3].

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