Ankylosing spondylitis: a dual perspective of current issues and challenges.

This series of articles on ankylosing spondylitis (AS) provides insight into the burden of disease and focuses on early diagnosis and effective management. AS leads to progressive functional impairment over time and has tremendous impact on society at large in terms of economic costs and indirect costs associated with physical impairment and loss of employment. Early diagnosis is crucial now that we have more effective therapy with tumor necrosis factor (TNF) antagonists, which suppress disease activity and improve the functional ability of patients whose disease is refractory to conventional drug therapy. Early identification of variables that help predict severe disease with bad functional prognosis is needed. If biological therapy with TNF inhibitors is proven to retard disease progression and prevent or delay functional limitations, insight into such prognosticators will help us offer the correct treatment to the correct patient at the correct time. There is also a need to demonstrate longterm benefits of such a therapy as well as a favorable cost/benefit ratio to help convince healthcare authorities, insurance companies, and others of the utility of these drugs for treating patients with AS refractory to conventional drug therapy.