9
Table 6. Treatment Recommendations for Axial Arthritis
GRADE
NSAIDs should be used to treat symptoms of axial disease in people with PsA.
• NSAIDs are conditionally recommended for patients with an inadequate response
(IR) to TNFi usually as an adjunct to further therapy.
S
Physiotherapy and simple analgesia should be used to treat symptoms of axial
disease in people with PsA.
S
Conventional DMARDs should NOT be used to treat symptoms of axial
disease in people with PsA.
S
NOT
TNF inhibitors should be used to treat symptoms of axial disease in people
with PsA that are not responding to NSAIDs.
S
IL12/23 inhibitors can be considered to treat symptoms of axial disease in
people with PsA that are not responding to NSAIDs.
C
IL17 inhibitors should be used to treat symptoms of axial disease in people
with PsA that are not responding to NSAIDs.
C
IL6 inhibitors should NOT be used to treat symptoms of axial disease in
people with PsA that are not responding to NSAIDs.
S
NOT
Anti-CD20 antibody should NOT be used to treat symptoms of axial disease
in people with PsA that are not responding to NSAIDs
S
NOT
Local injection of corticosteroid to the sacroiliac joints can be considered to
treat symptoms of axial disease in people with PsA that are not responding to
NSAIDs.
C
Bisphosphonate infusions can be considered to treat symptoms of axial disease
in people with PsA that are not responding to NSAIDs.
C
Switching TNF inhibitors or to an alternate targeted biological agent for
inadequate response or adverse effects can be considered to treat symptoms of
axial disease in people with PsA that are not responding to a previous targeted
biological agent.
• Conditional recommendation as formal data on switching TNFi for axial disease are
not available but observational data support switching in TNFi IR.
• Conditional recommendation as clinical trial data showing efficacy for secukinumab
(phase III trial) and ustekinumab (an open-label proof-of-concept trial with 20
patients) are published in AS, but these agents are currently not approved for AS or
axial PsA.
C
e treatment recommendations for axial disease are derived from diagnostic criteria,
screening, monitoring and response to therapy in ankylosing spondylitis (AS) since these data
are not available for axial PsA.
