From the Guidelines
Ankylosing Spondylitis (AS) Diagnosis and Treatment The diagnosis and treatment of Ankylosing Spondylitis (AS) involves a multidisciplinary approach, with the primary goal of maximizing long-term health-related quality of life through control of symptoms and inflammation, prevention of progressive structural damage, preservation/normalization of function, and social participation 1.
Diagnosis
AS is characterized by inflammatory back pain, radiographic sacroiliitis, excess spinal bone formation, and a high prevalence of HLA–B27 1. The diagnosis is based on a combination of clinical, genetic, and immunologic features, and may take years to develop.
Treatment
The mainstays of treatment for AS are:
- Non-pharmacological treatment: patient education, regular exercise, and physical therapy with supervised exercises, which are effective in improving symptoms and function 1.
- Pharmacological treatment: nonsteroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor inhibitors (TNFi) are commonly used to reduce symptoms and inflammation 1.
- Disease-modifying antirheumatic drugs (DMARDs): may be used in patients with peripheral arthritis.
Management
The optimal management of patients with AS requires a combination of non-pharmacological and pharmacological treatment modalities, and should be based on a shared decision between the patient and the rheumatologist 1. Regular updating and reassessment of treatment is necessary to keep abreast of new developments in the management of AS 1.
Key Recommendations
- Patient education and regular exercise are essential components of non-pharmacological treatment.
- NSAIDs and TNFi are effective in reducing symptoms and inflammation.
- DMARDs may be used in patients with peripheral arthritis.
- Treatment should be individualized and based on a shared decision between the patient and the rheumatologist.
- Regular updating and reassessment of treatment is necessary to optimize outcomes.
From the Research
Diagnosis of Ankylosing Spondylitis (AS)
- The diagnosis of AS is generally easy to make when the characteristic findings of the "bamboo" spine and fused sacroiliac joints are present on radiographs 2.
- However, these changes are usually seen late in the disease, and diagnostic delay averages seven to ten years 2.
- The detection of sacroiliitis by radiography, magnetic resonance imaging, or computed tomography in the presence of clinical manifestations is diagnostic for AS 3.
- Inflammatory back pain plus at least two other typical features of spondyloarthropathy (for example, enthesitis and uveitis) is highly predictive of early AS 3.
- The use of magnetic resonance imaging (MRI) to visualize the inflammatory changes in the sacroiliac joint and the axial spine can help identify AS in its earlier stages 2, 4.
Treatment of Ankylosing Spondylitis (AS)
- Non-steroidal anti-inflammatory drugs (NSAIDs) effectively relieve inflammatory symptoms and are presently first-line drug treatment 3.
- However, NSAID treatment has only a symptomatic effect and probably does not alter the disease course 3.
- Tumor necrosis factor (TNF) blocking agents are highly efficacious in reducing spinal inflammation and possibly in slowing radiographic progression 2, 5.
- TNF-α inhibitors have demonstrated efficacy and effectiveness in axSpA patients by reducing disease activity, minimizing inflammation, and improving the quality of life 6.
- New biologics and small molecules that target the IL-23/IL-17 axis and intracellular pathways are being developed and may improve the therapeutic armamentarium for AS 6.
- Appropriate and timely use of TNF-α antagonists offers additional options for patients with active AS who are inadequately controlled with conventional treatment 5.