Remission and possible discontinuation of biological therapy in axial spondyloarthritis.

Remission has not been a major topic in ankylosing spondylitis (AS) in recent years but there is now increasing interest in analogy to rheumatoid arthritis (RA). RA and AS are chronic inflammatory diseases with more differences than similarities. New classification criteria for axial spondyloarthritis (axSpA) have recently added patients with so called non-radiographic axSpA to the spectrum, hereby including earlier disease stages without structural changes. Therapeutic strategies include non-steroidal anti-inflammatory agents (NSAIDs) and biologics, mainly anti-TNF agents. Both work rather well for signs and symptoms, and possibly also for structure modification. Discontinuation of anti-TNF agents has been a major topic in RA in the last 2 years. In axSpA there has been less enthusiasm because early reports have been rather discouraging. However, no prospective controlled trials have been performed. This is a clear unmet need which should be addressed in future trials.