Figure 2. Management of Stable AS
Stable AS
NSAIDs
Use on-demand
NSAIDs & TNFi
Slow-Acting Drugs & TNFi
Physical Therapy
TNFi alone (monotherapy)
TNFi alone (monotherapy)
Monitor validated AS disease activity measure and CRP or ESR regularly
Unsupervised back exercises, formal group or individual self-management education, fall evaluation/counseling
LEGEND
• Strongly recommend
• Conditionally recommend
• Conditionally recommend against
• Strongly recommend against
• Qualifier
Active AS
NSAIDs
Use continuously
No preferred drug
Physical
Therapy
Active over passive
Land-based over aquatic
Systemic glucocorticoids
Consider if peripheral flare, pregnancy,
IBD flare
Slow-acting drugs (SSZ, pamidronate)
Consider if peripheral arthritis or TNFi contraindications
Remains active
×
Non-TNFi biologic
×
TNFI
No preferred drug
Use infliximab or adalimumab
Use TNFi monoclonals
Recurrent
iritis
IBD
Remains
active
Alternative TNFi
Local GC
Local GC
Local GC
Consider if ≤2 joints;
use infrequently
Avoid achilles, patellar,
quadriceps
Monitor validated AS disease activity measure and CRP or ESR regularly
Unsupervised back exercises, formal group or individual self-management education, fall evaluation/counseling
Isolated sacroiliitis
Peripheral arthritis
Enthesitis
Figure 1. Management of Active AS
TNFi Contraindication
