A growing amount of literature explores new technologies aimed at altering tumour necrosis factor (TNF) alpha activity in patients with ankylosing spondylitis. The Canadian Rheumatology Association has published a consensus on the use of these agents in the treatment of spondyloarthropies, recommending their use in some patients who are refractory to traditional therapy (i.e., NSAIDs, sulfasalazine in peripheral arthritis). The international consensus document, published subsequent to the Canadian guidlines, also suggests that a specialist should implement the use of anti-TNF alpha agents in refractory disease.
Several issues may be of concern: the price of the drug, its potential for long-term use, and the possibility of 'prescription creep' if higher than recommended dosage or increased dosage frequency are used. Unanswered questions remain regarding the optimal dose, long-term safety, and impact on disease progression. Although no trials have compared infliximab with other TNF alpha inhibitors such as etanercept, the choice of drug may be influenced by the route of administration (infliximab is administered intravenously, while etanercept is administered subcutaneously) and the perception of potential for harm.