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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ESpondyloarthritis (SpA) are a group of diseases which includes ankylosing spondylitis (AS), reactive arthritis, arthritis\/spondylitis with inflammatory bowel disease or psoriasis, and undifferentiated spondyloarthritis [\u003Cem\u003EAnn Intern Med\u003C\/em\u003E 2002;136:896\u2014907]. As a group, the SpA are one of the most common rheumatic diseases with a prevalence in the general population of 0.5\u20141.9% [\u003Cem\u003ERheum Dis\u003C\/em\u003E 2004;63:535\u2014543]. This article discusses state-of-the-art treatments and therapies.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Einflammatory disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EThe SpA are a group of diseases which includes AS, reactive arthritis, arthritis\/spondylitis with inflammatory bowel disease or psoriasis, and undifferentiated spondyloarthritis (\u003Cem\u003EAnn Intern Med.\u003C\/em\u003E 2002;136:896\u2013907). As a group, the SpA are one of the most common rheumatic diseases with a prevalence in the general population of 0.5\u20131.9% (\u003Cem\u003ERheum Dis.\u003C\/em\u003E 2004;63:535\u2013543).\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EDr. John Davis, University of California, San Francisco, CA, introduced the term \u201caxial SpA\u201d, which he believes perfectly describes the disease continuum consisting of the early phase of spondylitic disease without radiographic sacroiliitis (or axial undifferentiated SpA (uSpA) and the relatively later phase AS).\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ECommon features of these diseases include: enthesopathy, absence of radiographic sacroiliitis, and positive family history. Clinical features include: achilles tendonitis, plantar fasciitis, dactylitis, mononuclear cell infiltration including T-cells \u0026amp; macrophages, increase in inflammatory cytokines including IL-1, IL-6, TNF-\u03b1, subchondral bone inflammation and resorption, and periosteal new bone formation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EDr. Martin Rudwaleit, Charite\u0027- Campus Benjamin Franklin, Berlin, Germany, provided guidelines for use of several of the assessment techniques for SpA. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is the standard instrument used to measure disease activity, while the Bath Ankylosing Spondylitis Functional Index (BASFI) is used to measure physical function. Both are validated patient-reported instruments and Dr. Rudwaleit believes they are appropriate for daily clinical practice, unlike the ASessment in Ankylosing Spondylitis (ASAS) response criteria, which were designed to assess treatment response in clinical trials and are not appropriate for use in individual patient care.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EAccording to Dr. Herman Mielants, University Hospital Gent, Belgium, effective treatment strategies for SpA must go beyond the axial skeleton, joint, and enthesis. It must also have a beneficial effect on the extra-articular targets of the disease, including the skin, eye, gut and urogenital system. He reviewed several treatments.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EWith an average 60% response rate, NSAIDs are the cornerstone in the treatment of SpA. However, their effect on extra-articular targets is weak and they have been associated with GI side effects. Although COX-2 selective NSAIDs (coxibs) can minimize the stomach ulcers that are associated with traditional NSAIDs, they have no effect on extra-articular manifestations and have potential side effects of their own (eg, stomach upset, diarrhea, abdominal cramps, and headaches). Corticosteroids can act favorably on gut inflammation and locally on the eye, skin and joints but have no effect on axial inflammation. DMARDs (sulfasalazine, methotrexate, leflunomide) have been proven effective for arthritis, tendonitis, and skin involvement, but they have no effect on axial disease or disease progression and generally require regular blood tests to monitor side effects.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThree biologics (infliximab [\u003Cem\u003EArthritis Rheum.\u003C\/em\u003E 2005; 52:582\u201391], etanercept [\u003Cem\u003EArthritis Rheum.\u003C\/em\u003E 2003; 48: 3230\u20133236], adalimumab [\u003Cem\u003EArthritis Rheum.\u003C\/em\u003E 2006; 54:2136\u20132146]) have been approved for the treatment of SpA and all show impressive effects on locomotor and extra-articular manifestations, metrology, and quality of life. Only infliximab and adalimumab produce improvement of gut inflammation in irritable bowel disease. Infliximab significantly reduces the frequency of flares of uveitis (etanercept\u0027s effect is less positive and adalimumab\u0027s is still unknown). Recent studies show that infliximab also delays structural radiological progression compared with NSAIDs; this has not yet been demonstrated for etanercept or adalimmumab. All are associated with an increased risk of infections (e.g., tuberculosis and opportunistic infections).\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThe increasing interest in the spondyloarthritides, the availability of validated assessment tools, and the clinical studies being conducted in this population, hold promise for strides in early diagnosis and treatment.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EFor more information about the BASFI, please visit: \u003Ca href=\u0022http:\/\/www.spondylitis.org\/physician_resources\/assesment.aspx\u0022\u003Ehttp:\/\/www.spondylitis.org\/physician_resources\/assesment.aspx\u003C\/a\u003E\n         \u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/3\/30.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm5lq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}