Treatment Guidelines for Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthritis

The American College of Rheumatology in conjunction with the Spondylitis Association of America and the Spondyloarthritis Research and Treatment Network, has updated treatment recommendations for ankylosing spondylitis and non-radiographic axial spondyloarthritis.The guidelines, last updated in 2015, were developed to reflect the incorporation of new medications to treat axial spondyloarthritis focusing on questions for which new evidence has been found to provide answers. The 2019 update was motivated by the availability of new treatment options such as secukinumab, ixekizumab, tofacitinib, and tumor necrosis factor inhibitor biosimilars as well as emerging best practices for imaging utilization for patients with axial SpA.The guidelines were published August 22 in Arthritis & Rheumatology.Key changes include using TNF inhibitors over secukinumab or ixekizumab as the first biologic prescribed with secukinumab or ixekizumab being recommended in patients failing TNF inhibitor treatment. With regards to diagnosing patients with unclear disease activity, spine or pelvis magnetic resonance imaging may be of use while routine monitoring radiographs are not recommended.86 treatment recommendations were made for adults with active ankylosing spondylitis and adults with active nonradiographic axial spondyloarthritis. The recommendations range from high to very low. In this slideshow, we highlight those categorized as “strongly” recommended.REFERENCE: Michael M. Ward MD, MPH  Atul Deodhar MD, MRCP  Lianne S. Gensler MD, et al. "2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis." Arthritis and Rheumatology. Aug. 22, 2019. https://doi.org/10.1002/art.41042