← Map/THREAD · TNF-INHIBITION
TNF-α Inhibition
The first major shift in AS treatment. Still first-line in most guidelines.
Why this is a thread
TNF blockers were the first major shift in AS treatment. They include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi), and certolizumab (Cimzia). Most guidelines still place them as first-line treatment for AS, they remain the most-prescribed biologic class. Papers in this thread cover their mechanism, comparative effectiveness, immunogenicity (when patients build up antibodies that reduce the drug's effect), and how they sit alongside the newer drug classes that came after them.
5 papers on the board
Current status and emerging trends in biological therapies for ankylosing spondylitis: a bibliometric analysis (2004–2024)
Medicine (LWW)
Bibliometric analysis of biological therapies for AS over 2004-2024. Confirms three pillars, TNF, IL-17, and JAK inhibitors, and a persistent inadequate response in a meaningful subset of patients across all three classes.
Recent advances in biologic therapies for ankylosing spondylitis: a 2024 update
Allergologia et Immunopathologia
Comprehensive bDMARD review covering TNF, IL-17, and JAK inhibitor classes with their efficacy and safety profiles across the AS treatment landscape. Confirms a meaningful patient subset still has inadequate response across all three drug classes.
Advances in Axial Spondyloarthritis Treatment: The Role of Janus Kinase Inhibitors
International Journal of Rheumatic Diseases
Reviews the JAK inhibitor class, tofacitinib, upadacitinib, filgotinib, for axial spondyloarthritis. The 2025 CRA/SPARCC guidelines still place TNF inhibitors first-line, with JAK inhibitors recommended when TNFi is contraindicated or for patients with comorbid IBD.
The role of ETS2 in macrophage inflammation
DNA and Cell Biology
Direct follow-up to the 2024 Nature paper. Shows that ETS2 turns on several inflammatory signals at once, TNF, IL-23, IL-1β, and TL1A, the same signals current biologic drugs target one at a time.
Gut microbiota in rheumatoid arthritis: mechanistic insights, clinical biomarkers, and translational perspectives
Autoimmunity Reviews
Review of the gut microbiota in rheumatoid arthritis, with diet as an upstream variable: Western diet → dysbiosis → inflammation; Mediterranean and plant-based diets → microbial diversity → immune tolerance. Same dysbiosis mechanism as the AS papers, with an environmental modifier layer the AS papers don't yet emphasise.