La prise en charge des patients souffrant de spondylarthropathie est en train d'etre bouleversee sur plusieurs points et pour differentes raisons. Il semble que la raison essentielle tienne a une meilleure prise de conscience de la relative grande prevalence de ce groupe d'affections (voisine de celle de la polyarthrite rhumatoide). L'appreciation des differentes modalites therapeutiques est maintenant facilitee grace a une standardisation des criteres d'evaluation obtenue a l'echelon international via le groupe ASAS (ASsessment in Ankylosing Spondylitis). L'evaluation des traitements non pharmacologiques comme les exercices physiques, mais egalement l'information des patients est facilitee par la conduite d'essais therapeutiques controles. Les anti-inflammatoires non steroidiens sont toujours la base du traitement medicamenteux. Les etudes recentes montrent que les inhibiteurs specifiques de la cyclooxygenase de type<space>II sont mieux toleres au plan digestif et tout aussi efficaces sur les symptomes cliniques que les anti-inflammatoires non steroidiens conventionnels. Enfin, et d'importance, il semble que des therapeutiques de fond peuvent etre efficaces, non seulement sur les manifestations articulaires peripheriques, mais egalement chez les patients souffrant d'atteinte axiale refractaire aux AINS. C'est notamment le cas du thalidomide et des anti-TNF.
The management of patients with spondyloarthropathy is undergoing radical changes in several areas and for several reasons. The main reason seems to be improved awareness of the fairly high prevalence of this group of disorders, which is close to that of rheumatoid arthritis. Evaluation of the various treatment modalities has benefited from work by the international ASsessment in Ankylosing Spondylitis group (ASAS) group aimed at developing standardized evaluation criteria (). Controlled treatment trials have provided useful information on nonpharmacological treatments such as physical exercise programs and patient information. Nonsteroidal anti-inflammatory drugs (NSAIDs) remain the cornerstone of the pharmacological treatment. Recent studies have shown that NSAIDs capable of selectively inhibiting type 2 cyclooxygenase have a better gastrointestinal safety profile and are as effective in relieving clinical symptoms as conventional NSAIDs. Importantly, maintenance treatment seems effective not only on peripheral joint manifestations but also on axial manifestations that fail to respond to NSAIDs. Thalidomide and TNF antagonists are promising maintenance agents.