New Ankylosing Spondylitis, Axial Spondyloarthritis Guidelines Released

New guidelines have been released by a conglomerate of rheumatology and spondylitis organizations for the treatment of ankylosing spondylitis and axial spondyloarthritis.

The 2019 Update of the Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis, which includes 86 recommendations that provide new and updated guidance on management of patients, were released earlier this week by the American College of Rheumatology (ACR) in partnership with the Spondylitis Association of America and the Spondyloarthritis Research and Treatment Network. 



“We hope this new information will help get patients on an effective treatment faster and ultimately improve patients’ health status and quality of life,” said Michael Ward, MD, MPH, researcher at the National Institute of Arthritis and Musculoskeletal and Skin Diseases and principal investigator of the guideline.

The new guidelines — which contain updates in a variety ion areas including pharmacologic and non-pharmacologic treatment options, AS-related comorbidities, and disease activity assessment, imaging, and screening — are the first updates to the ACR’s 2015 guidelines and are based on a systematic literature review by a team of investigators. The 2019 update builds on previous recommendations by best practices for imaging, managing biologic and biosimilars usage in patients, and providing information on new medications.

The systematic review included 20 clinical questions on pharmacological treatment addressed in the 2015 guidelines and 26 new question on the pharmacological treatment, treat-to-target strategy, and use of imaging. Additionally, the results of the review were debated by a separate voting panel and recommendations were labeled conditional or strong based on the available evidence. 


“Based on the literature, we felt it was important to address topics such as sequencing biologics for patients with active AS despite NSAID usage, whether to taper or discontinue biologics in the setting of remission, and clearer guidelines on when to obtain images — particularly in instances when results would likely lead to a change in treatment,” Ward said.

A release from the American College of Rheumatology highlighted multiple recommendations from the new guideline including a strong recommendation to treat adults with active AS despite treatment with nonsteroidal anti-inflammatory drugs (NSAIDS) with a tumor necrosis factor inhibitor (TNFi) over no treatment with a TNFi, a strong recommendation to continue treatment with the originator biologic over mandated switching to its biosimilar for adults with stable AS, and A conditional recommendation to treat with a TNFi over treatment with secukinumab, ixekizumab or tofacitinib, and a conditional recommendation to treat with seukinumab or ixekizumab over tofacitinib.

The release also noted a conditional recommendation against obtaining repeat spine radiographs at a scheduled interval as a standard approach for adults with active or stable nonradiographic axial spondyloarthritis on any treatment.

The “2019 Update of the Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis,” is published on the American College of Rheumatology website.