The Janus kinase inhibitor (JAKi) class has been increasingly used in the management of axial spondyloarthritis (axSpA) over the past five years, offering effective oral alternatives to injectable biologics. But are all JAK inhibitors the same?

The last day in London was exciting as both the Late-Breaking abstracts and new EULAR guidelines were presented. Guidelines presented addressed several significant unmet need areas including PMR, GCA, Takayasu’s arteritis, Vaccinations in Rheumatic patients, Imaging in spondyloarthritis and classification criteria for the Anti-Synthetase Syndrome. Here are but a few of my favorites from a list of many quality sessions.

ASAS and the SPARTAN have updated their key classification criteria for axial SpA (axSpA). EULAR has also recently revised their recommendations on the role of imaging in the diagnosis and clinical management of spondyloarthritis (SpA). Both were presented at the EULAR 2026 annual Congress in London.

The approach to the treatment of peripheral SpA has been the same for a long time. The guidelines recommend starting with NSAIDs, escalate to conventional synthetic DMARDs, typically sulfasalazine or methotrexate and reserve biologics for patients who fail those. According to a new phase 3 trial presented at EULAR 2026, there may be a different way to approach this.

At EULAR 2026, two large phase 3 studies highlight that the JAK story in axSpA is still evolving rapidly, with different selectivity profiles and expanding global development programs continuing to push the field forward.

Clinicians often come across the scenario of a patient with well-controlled spondyloarthritis where the ASDAS in the low disease activity range, CRP normalised, joints clinically quiet. However, the patient returns to the clinic still reporting significant pain. Their rheumatologist adjusts the biological, waits, returns. The pain persists.