Axial spondyloarthritis treatment recommendations

  • Mary Corcoran
  • Univadis Medical News
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The Asia‐Pacific League of Associations for Rheumatology has published new recommendations on the treatment of axial spondyloarthritis (SpA) in the International Journal of Rheumatic Diseases.

Fourteen treatment recommendations were developed based on evidence summaries and consensus. These include: 

  • Strong recommendation for nonsteroidal anti-inflammatory drugs (NSAIDs) for patients with active axial SpA as first‐line treatment for symptom control.
  • Strong recommendation against the long‐term use of corticosteroids.
  • Conditional recommendation for the use of conventional synthetic disease‐modifying anti‐rheumatic drugs (csDMARDs) for patients with peripheral or extra‐articular manifestations or in resource‐poor settings.
  • Strong recommendation for the use of biological DMARD (bDMARDs) in patients with active disease who have failed treatment with two different NSAIDs. 
  • Prior to starting bDMARD, screen for tuberculosis, hepatitis B virus, hepatitis C virus and human HIV (in high‐risk populations).
  • Strong recommendation to use a TNF-inhibitor as initial bDMARD treatment. 
  • Conditional recommendation for use of TNF-inhibitor monoclonal antibodies over fusion protein in patients with features beyond arthritis and enthesitis, such as concomitant inflammatory bowel disease, recurrent anterior uveitis and psoriasis.
  • Conditional recommendation for treatment with another TNF-inhibitor or secukinumab in adults with persistent active axial SpA despite an adequate trial of the first TNF-inhibitor for at least 12 weeks.

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