Evolving Role of Biological Response Modifiers in the Management of Arthritis and Spondylitis

Rheumatoid Arthritis (RA) is a common condition and remarkable gains have been made in its management with the use of combinations of anti-rheumatic drugs including methotrexate, cyclosporine and leflunomide. Yet the patient response parameter in the form of “complete remission” is extremely rare even with the best of care and the burden of damaged joints for each afflicted patient increases every year. Similarly, spondyloartropathies (SpAs) which are nearly as common as RA, are prototypical of the Inflammatory Spine pain conditions that present to the Orthopaedic surgeon and to the Rheumatologist. With the proof that TNF-alpha is involved in the pathogenesis of inflammatory joint and spinal pain, clinical trials of Biological Response Modifiers or BRMs (Anti-TNF-alpha agents) set the pace for newer treatment protocols with extremely encouraging results. The following is a review of the science of the biologicals and their clinical use in rheumatoid arthritis and spondyloarthropathies (ankylosing spondylitis, psoriatic arthritis, etc).