The American College of Rheumatology, in conjunction with the Spondylitis Association of America and the Spondyloarthritis Research and Treatment Network, has released new recommendations for both pharmacologic and non-pharmacologic treatment of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (SpA).

The recommendations cover treatment of patients with active or stable AS (pharmacologic and rehabilitation) and treatment of patients with AS and specific impairments or comorbidities (eg, advanced hip arthritis, severe kyphosis, acute iritis, and inflammatory bowel disease). It also includes recommendations for the treatment of patients with non-radiographic axial SpA and education and preventive care recommendations for AS and SpA.

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In patients with active AS, use of nonsteroidal anti-inflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, no use of systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis are all strongly recommended. Condition recommendations included no particular TNFi preference except in patients with concomitant inflammatory bowel disease or recurrent iritis (in whom TNFi monoclonal antibodies should be used). In patients with active nonradiographic axial SpA despite treatment with NSAIDs, treatment with TNFi is conditionally recommended.

The guideline also notes that additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas. The recommendations will be updated as new evidence is discovered and new treatments are available.

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