Treatment
Table 3. Rehabilitation
Active AS
Evidence
Quality
a
e ACR strongly recommends treatment with physical therapy over no
treatment with physical therapy.
Moderate
e ACR conditionally recommends active physical therapy interventions
(supervised exercise) over passive physical therapy interventions (massage,
ultrasound, heat).
Very Low
e ACR conditionally recommends land-based physical therapy
interventions over aquatic therapy interventions.
Moderate
Stable AS
Evidence
Quality
In adults with stable AS, the ACR strongly recommends treatment with
physical therapy over no treatment with physical therapy.
Low
Either Active or Stable AS
Evidence
Quality
e ACR conditionally recommends advising unsupervised back exercises. Moderate
For patients who also have had spinal fusion or who have advanced spinal
osteoporosis, the ACR strongly recommends against treatment with spinal
manipulation.
Very Low
a
See Table 10 for GRADE Scores of Quality of Evidence.
Table 2. Pharmacological Treatment of Adults with Stable AS
Evidence
Quality
a
e ACR conditionally recommends on-demand treatment with NSAIDs
over continuous treatment with NSAIDs.
Very Low
IF on treatment with TNFi and NSAIDs, the ACR conditionally
recommends continuing treatment with TNFi alone compared to
continuing both treatments.
Very Low
IF on treatment with TNFi and SAARDs, the ACR conditionally
recommends continuing treatment with TNFi alone over continuing both
treatments.
Very Low
a
See Table 10 for GRADE Scores of Quality of Evidence.
