Traditionally, nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic agents (DMARDs) have been used to control the symptoms of spondyloarthropathy. With the advent of anti-tumor necrosis factor alpha (anti-TNF-alpha) agents, however, it is now possible to slow disease progression, improve overall function, and provide symptomatic relief of arthritis, skin lesions, and bowel inflammation associated with these disorders. Here, Drs Anandarajah and Ritchlin explore the effectiveness of conventional therapies as well as biologic agents that are currently available or under development.