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Update: axSpA Recommendations

  • EurekaAlert!

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic musculoskeletal disease which can be managed with both pharmacological and non-pharmacological options. The joint ASAS-EULAR recommendations for axSpA were first developed in 2006, and last updated in 2016. The current update reflects newly available evidence since the last version.

The updated recommendations were developed by a multidisciplinary task force of 33 members from 16 countries.

The paper developed by EULAR and published in October 2022 issue of the Annals of the Rheumatic Diseases includes 5 overarching principles and 15 recommendations with a focus on personalized medicine. The principles say that axSpA is a potentially severe disease with diverse manifestations, usually requiring multidisciplinary management coordinated by the rheumatologist, but based on a shared decision between the patient and the rheumatologist that also takes into account the high individual, medical, and societal costs. The primary goal of treating axSpA is to maximise long-term health-related quality of life through control of symptoms and inflammation, prevention of progressive structural damage, and preservation or normalization of a person’s function and social participation. Optimal management requires a combination of non-pharmacological and pharmacological treatment modalities.

Of the 15 recommendations, 8 were unchanged from the previous recommendations, 2 were entirely new, and the remainder had minor edits or updates. The recommendations focus on treatment target and monitoring, non-pharmacological management and pharmacological treatment, from appropriate first-line choices to later lines of therapy and specific clinical scenarios such as surgery and fractures. Of note, the long-term use of glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement is discouraged.

In addition, the group put together a new research agenda, and a dissemination strategy is currently underway which should enhance uptake and implementation of the recommendations.

It is hoped these updated recommendations provide healthcare professionals and other relevant stakeholders with the most up-to-date evidence and expert insights in the management of people with axSpA. It is EULAR’s vision that these recommendations standardize and further optimize the treatment of people living with axSpA, contributing to both individual well-being as well as wider societal benefit through better management of the disease.


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The author has no conflicts of interest to disclose related to this subject