Ankylosing spondylitis (AS) is a chronic inflammatory disorder with predilection for the axial skeleton, leading
to progressive restricted mobility and deformity of the spine. The fundamental mechanism involves autoimmunity
orchestrated by T cells. Similar to other rheumatic diseases, the complex interplay of cytokines such as tumour necrosis
factor alpha, interleukin-6 (IL 6) and interleukin-10 (IL 10) has been implicated in the pathogenesis of the disease.
Despite extensive research over the past decades, the treatment options for AS, are limited. Non steroidal antiinflammatory
drugs are the first line of therapy, whereas anti TNF drugs are administered for refractory cases which fail
to respond to the treatment. There have been conflicting views on the correlation of IL 6 with disease activity in AS. As
such, the debate on the role of anti IL6 in AS is still ongoing. Anti IL 6 such as tocilizumab and siltuximab have proven
efficacy based on the large randomized controlled trials. The Food and Drug Administration (FDA) has approved these
drugs for treating rheumatoid arthritis and systemic juvenile idiopathic arthritis. Researchers have adventurously
experimented anti IL 6 therapy in AS but the conclusions made were not consolidated into international guidelines or
consensus statement for clinical practice. In the present review, we explore the role of anti IL6 in the treatment of AS
based on the cumulative evidence over recent years.
Keywords: Ankylosing spondylitis, inflammation, interleukin 10, interleukin 6, pathogenesis, treatment, tumour necrosis
factor, T cells, cytokines, anti TNF drugs
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