Use of TNF blockers with particular reference to etanercept treatment in patients with ankylosing spondylitis based on data from the literature and own observations

Introduction and objectives : Ankylosis spondylitis (AS) is a chronic rheumatic disease characterized by inflammatory back pain due to sacroiliitis and spondylitis, which affects mainly young men. Peripheral joints and extraarticular tissue as well as the cardio-vascular system and anterior uvea may also be affected. Anti-TNF therapy is highly effective in AS. TNF inhibitors not only significantly reduce the signs and symptoms of AS but also improve the quality of life of patients. The aim of the study was to examine safety and efficacy of 12-month treatment with etanercept of AS patients who have not been treated with biological agents before.

Material and methods : Six AS patients were studied (mean age 35.7 years, all patients were in an advanced stage of disease – sacroiliitis III/IV, spondylitis III – mean duration of the disease 11.3 years – Table I). Efficacy of treatment was assessed by means of mobility of the vertebral column, chest expansion, number of tender and swollen joints, disease activity VAS, pain VAS, Bath Ankylosis Spondylitis Functional Index (BASFI), Bath Ankylosis Spondylitis Disease Activity Index (BASDAI). Disability was measured by HAQ questionnaire. The erythrocyte sedimentation rate (ESR) and CRP protein concentration were measured. All parameters were assessed every 3 months (Fig. 1, 2). Previous treatment is shown in Table II.

Results : All parameters improved during the observation (Table III, IV, V). After treatment, CRP concentration statistically decreased significantly. No adverse events were observed.

Conclusion : Small size of the group allows for preliminary conclusions. Etanercept therapy reduced pain and morning stiffness, which was not observed after the standard therapy. One-year etanercept therapy was effective and well tolerated. No serious adverse events were observed.