New recommendations for the treatment of patients with ankylosing spondylitis and nonradiographic axial spondyloarthritis largely echo each other in many respective clinical circumstances that are addressed for active and stable disease, including strongly advising the use of nonsteroidal anti-inflammatory drugs and physical therapy as initial therapy.
The recommendations, issued by the American College of Rheumatology (ACR), the Spondylitis Association of America, and the Spondyloarthritis Research and Treatment Network, are the same as those outlined at the 2014 ACR annual meeting in advance of their simultaneous publication Sept. 24 in Arthritis & Rheumatology ( doi: 10.1002/art.39298 ) and Arthritis Care & Research ( doi: 10.1002/acr.22708 ).
The main difference in recommendations for the treatment of active ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA) is that in patients with active AS despite treatment with NSAIDs, treatment with a tumor necrosis factor inhibitor (TNFi) is strongly advised, whereas for patients with nonradiographic axial SpA, a TNFi is conditionally recommended over no treatment with a TNFi. The authors noted that this treatment question “had the highest level of evidence among those for nonradiographic axial SpA.”
The authors also said that the recommendations are limited in that they “did not examine the full range of treatment alternatives for patients with active peripheral arthritis or enthesitis, advanced options for patients who do not respond to first- and second-level systemic treatments, use of analgesics, or the use of imaging in disease monitoring.” They also did not address the cost-effectiveness of treatment options.
