Top Docs TNF Blockers

Ankylosing spondylitis is a pain in the neck — literally. And nobody knows better than Dr. Muhammad Khan, who has suffered from AS for more than 50 years.

The chronic inflammatory arthritic disease can limit spinal mobility, restrict chest expansion, cause severe back pain and limit range of motion in the neck. Eventually, it can result in complete fusion of the spine — like Khan’s — which occurs when segment of a patient’s vertebrae fuse together.

For more than 50 years, anti-inflammatory drugs were the mainstay treatment, but they’re only ef-fective in relieving pain and stiffness. Those who suffered needed something stronger.

Khan, a rheumatologist at MetroHealth Rehabilitation Institute of Ohio and professor of medicine at Case Western Reserve University’s School of Medicine, advocates a new therapy called tumor necrosis fac-tor (TNF) blockers. These drugs inhibit the function of protein signals enabling one cell to communicate with another. The cells’ message is systematic inflammation, which causes autoimmune disorders such as AS.

The most common TNF blockers — Enbrel, Remicade and Humira — are biologically engineered pro-tein molecules that soak up excess TNF before it can attach to natural TNF receptors. Another TNF blocker, Remicade, uses human and mouse proteins to create an antibody that binds to TNF-alpha, ren-dering it inactive. Studies show that all three drugs decrease joint damage and slow the progress of AS in the majority of clinical cases, though little is known about their long-term effects.

“The advent of biological therapy with TNF blockers is currently revolutionizing management of the disease,” says Khan. This month, he plans to open the first clinic in Ohio devoted to the management of AS, hoping to convince health care officials, insurance companies and others of the utility of TNF blockers.