(v) Biological therapy in the management of inflammatory arthritis with particular reference to orthopaedic surgery

Research over the past 20 years has identified that tumour necrosis factor-α is one of the key cytokines in the pathogenesis of rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. This has led to targeted disease modifying therapies, the “biological agents” which have revolutionised modern rheumatology practice. This article outlines the currently available biological therapies, their indications, modes of action, benefits and potential side effects together with the current advice on their use at times of general and orthopaedic surgery.