New Treatment Guidelines for Ankylosing Spondylitis
AS treatments become available as information about diagnosis and treatment evolves. It’s natural for treatment guidelines for diseases and conditions to change and get updated. This helps to ensure that patients get the most up-to-date care for their condition. It also ensures health care professionals have current knowledge of best practices for their patients. New treatment guidelines were recently released for ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis. The updates were based on a large literature review, and they build on guidelines that already exist. They also provide new guidelines and information about treatments.
How did they decide on the new treatment guidelines
The 2019 Update of the Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis includes 86 recommendations. These updates may not be applicable to everyone.1 These guidelines were developed by the American College of Rheumatology (ACR), who partnered with the Spondylitis Association of America and the Spondyloarthritis Research and Treatment Network. The overarching goal was to help patients get treatment faster, which in turn, helps improve health status and quality of life.
What are the updates about?
The guidelines are the first updates in 4 years, and address medication and non-medication treatment options. They include information about1:
- AS-related comorbidities
- Disease activity assessment (or how active your disease is)
- Imaging tests and screening, and
- Managing biologic and biosimilars
The update was done in part because of all of the new treatment options like biosimilars, and how this affects the older medications that have been given – and where they fit in the current care system.2
Why did the guidelines change?
The main motivation for the changes was, as mentioned, the slew of new treatment options. There were also clinical questions about the medication treatments as well as the use of imaging. The results of the literature review were then debated by a separate voting panel. Then, the proposed recommendations were then labeled based on the evidence.1 This is to ensure that these changes are based on good data and worthwhile for patients.
Things to know about the new guidelines
Since there are 86 recommendations, patients should talk with their doctor about the new guidelines and whether there are any that affect their care. Each patient is different, and your doctor will be able to tell you whether the new treatment guidelines will affect your care.
Some recommendations from the new guidelines that were highlighted in an ACR release include1,2:
- Strong recommendation to treat adults with active AS who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) with a tumor necrosis factor inhibitor (TNFi) over no TNFi treatment
- Strong recommendation to continue treatment with the originator biologic than switching to a biosimilar drug for adults with stable AS
- Conditional recommendation to treat with a TNFi rather than with secukinumab, ixekizumab, or tofacitinib
- Conditional recommendation to treat with secukinamab or ixekizumab over tofacitinib
- Conditional recommendation against repeat spine radiographs at scheduled intervals as a standard approach for adults with active or stable nonradiographic axial SpA who are receiving treatment
- Conditionally in favor of use of sulfasalazine in limited clinical circumstances
- MRI is not recommended to search for inflammation in patients with axial SpA
What does this mean for people who have AS?
For some people, it may mean nothing at all; for others, it might mean looking at other medications or fewer imaging tests. Your doctor can discuss with you the new recommendations that affect your care, and together, you can come up with a treatment plan in which you’re both comfortable and confident. It’s important to remember that these guidelines are not blanket statements, and in the end, clinical judgment, individual medical history and treatment response, individual clinical assessment, and patient preference all impact your treatment plan.
Other than back pain and fatigue, what is the most common symptom that AS patients experience?