Anti–TNF-α Therapy for Ankylosing Spondylitis — A Specific or Nonspecific Treatment?

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Abstract
The spondyloarthropathies comprise ankylosing spondylitis, reactive arthritis, arthritis that accompanies inflammatory bowel disease, some forms of psoriatic arthritis, and undifferentiated forms of spondyloarthropathy. The report in this issue of the Journal by Gorman et al.1 focuses on ankylosing spondylitis, a seronegative spondyloarthropathy that is associated with HLA-B27 in about 90 percent of patients. HLA-B27 has a role in the binding of antigenic peptides and in their presentation to CD8+ T cells. HLA-B27–restricted cytotoxic T cells with specificity for bacteria, viral peptides, or autoantigens that cause arthritis, such as peptides derived from the HLA-B27 molecule itself, have been identified in patients . . .