ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update

Ramiro, S.; Nikiphorou, E.; Sepriano, A.; Ortolan, A.; Webers, C.; Baraliakos, X.; ... ; Heijde, D. van der (2022)

Article / Letter to editor

Objectives To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). Methods Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. Results Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6-8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score >= 2.1 and failed >= 2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. Conclusions The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.

• Spondyloarthritis
• Biological Therapy
• Therapeutics

• All authors: Ramiro, S.; Nikiphorou, E.; Sepriano, A.; Ortolan, A.; Webers, C.; Baraliakos, X.; Landewe, R.B.M.; Bosch, F.E. van den; Boteva, B.; Bremander, A.; Carron, P.; Ciurea, A.; Gaalen, F.A. van; Geher, P.; Gensler, L.; Hermann, J.; Hooge, M. de; Husakova, M.; Kiltz, U.; Lopez-Medina, C.; Machado, P.M.; Marzo-Ortega, H.; Molto, A.; Navarro-Compan, V.; Nissen, M.J.; Pimentel-Santos, F.M.; Poddubnyy, D.; Proft, F.; Rudwaleit, M.; Telkman, M.; Zhao, S.S.; Ziade, N.; Heijde, D. van der
• Date: 2022-10-21
• Journal: Annals of the Rheumatic Diseases
• Volume: 82
• Issue: 1
• DOI: doi:10.1136/ard-2022-223296