Key Points
Key Points
` Ankylosing spondylitis (AS) is a form of chronic inflammatory arthritis
characterized by sacroiliitis, enthesitis, and a marked propensity for
sacroiliac joint and spinal fusion.
` Non-radiographic axial spondyloarthritis (nr-axSpA) encompasses patients
with chronic back pain and features suggestive of spondyloarthritis but who
do not meet classification criteria for AS.
` The goals of treatment of AS and nr-axSpA are to reduce symptoms,
maintain spinal flexibility and normal posture, reduce functional limitations,
maintain work ability, and decrease disease complications.
Key Recommendations
` In adults with active AS, the ACR strongly recommends treatment with
NSAIDs over no treatment with NSAIDs.
` In adults with active AS despite treatment with NSAIDs, the ACR strongly
recommends treatment with TNFi compared to no treatment with TNFi.
` In adults with active AS, the ACR does not recommend any particular TNFi
as the preferred choice, except for patients with concomitant inflammatory
bowel disease or recurrent iritis.
` In adults with AS and inflammatory bowel disease, the ACR strongly
recommends treatment with infliximab or adalimumab over treatment with
etanercept.
` In adults with active AS, the ACR strongly recommends against treatment
with systemic glucocorticoids.
` In adults with active AS, the ACR strongly recommends treatment with
physical therapy over no treatment with physical therapy.
` In adults with AS and advanced hip arthritis, the ACR strongly recommends
treatment with total hip arthroplasty over no surgery.
` In adults with active nonradiographic axial SpA despite treatment with
NSAIDs, the ACR conditionally recommends treatment with TNFi compared
to no treatment with TNFi.
