A type of inflammatory arthritis that affects the spine but cannot be detected by x-ray now has an approved treatment. The US Food and Drug Administration has authorised Cimzia (certolizumab pegol) for the treatment of non-radiographic axial spondyloarthritis, a disease that starts in patients under the age of 45 years and can get progressively worse. The fact that the disorder cannot be identified by x-ray sets it apart from other inflammatory conditions in the same disease group.