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Review
. 2019 Oct;71(10):1285-1299.
doi: 10.1002/acr.24025. Epub 2019 Aug 21.

2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

Michael M Ward  1 , Atul Deodhar  2 , Lianne S Gensler  3 , Maureen Dubreuil  4 , David Yu  5 , Muhammad Asim Khan  6 , Nigil Haroon  7 , David Borenstein  8 , Runsheng Wang  9 , Ann Biehl  1 , Meika A Fang  10 , Grant Louie  11 , Vikas Majithia  12 , Bernard Ng  13 , Rosemary Bigham  14 , Michael Pianin  15 , Amit Aakash Shah  16 , Nancy Sullivan  17 , Marat Turgunbaev  16 , Jeff Oristaglio  17 , Amy Turner  16 , Walter P Maksymowych  18 , Liron Caplan  19
Affiliations
Review

2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

Michael M Ward et al. Arthritis Care Res (Hoboken). 2019 Oct.

Abstract

Objective: To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).

Methods: We conducted updated systematic literature reviews for 20 clinical questions on pharmacologic treatment addressed in the 2015 guidelines, and for 26 new questions on pharmacologic treatment, treat-to-target strategy, and use of imaging. New questions addressed the use of secukinumab, ixekizumab, tofacitinib, tumor necrosis factor inhibitor (TNFi) biosimilars, and biologic tapering/discontinuation, among others. We used the Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations and required at least 70% agreement among the voting panel.

Results: Recommendations for AS and nonradiographic axial SpA are similar. TNFi are recommended over secukinumab or ixekizumab as the first biologic to be used. Secukinumab or ixekizumab is recommended over the use of a second TNFi in patients with primary nonresponse to the first TNFi. TNFi, secukinumab, and ixekizumab are favored over tofacitinib. Co-administration of low-dose methotrexate with TNFi is not recommended, nor is a strict treat-to-target strategy or discontinuation or tapering of biologics in patients with stable disease. Sulfasalazine is recommended only for persistent peripheral arthritis when TNFi are contraindicated. For patients with unclear disease activity, spine or pelvis magnetic resonance imaging could aid assessment. Routine monitoring of radiographic changes with serial spine radiographs is not recommended.

Conclusion: These recommendations provide updated guidance regarding use of new medications and imaging of the axial skeleton in the management of AS and nonradiographic axial SpA.

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Figures

Figure 1.
Figure 1.
Summary of the main recommendations for the treatment of patients with active ankylosing spondylitis (panel A) and stable ankylosing spondylitis (panel B).
Figure 1.
Figure 1.
Summary of the main recommendations for the treatment of patients with active ankylosing spondylitis (panel A) and stable ankylosing spondylitis (panel B).
See this image and copyright information in PMC

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