[Early therapy of axial spondyloarthritis and relevance of radiological progression].

In recent years great achievements have been made in terms of early diagnosis of axial spondyloarthritis (SpA). In addition new classification criteria have been established. An early diagnosis offers the possibility for effective early treatment. For the treatment of axial SpA according to the Assessment of Spondyloarthritis International Society-European League Against Rheumatism (ASAS-EULAR) recommendations non-steroidal anti-inflammatory drugs (NSAIDs) should be used first. In cases of non-response to at least 2 different NSAIDs given for at least 4 weeks, tumor necrosis factor alpha (TNF-α) blocking agents can be used. Data from three clinical trials with TNF-α blockers in early axial SpA showed that clinical remission can be reached in about 50% of cases. Furthermore, it could be shown that during TNF-α blocking treatment acute inflammatory lesions of the sacroiliac joints, the spine and entheses could be effectively reduced in magnetic resonance imaging (MRI). Recently a close interaction between acute inflammation, TNFα blockade and the development of fatty lesions could be shown. This is an important step for understanding the process of radiographic progression in axial SpA. Early treatment might prevent radiographic progression.