Ankylosing spondylitis (AS), the major subtype and a major outcome of an interrelated group of rheumatic diseases named spondyloarthritides (SpA), is part of the subgroup with predominant axial symptoms that is now named axial SpA (axSpA), the other part non-radiographic axial SpA. The most important clinical symptom of axSpA is inflammatory back pain (IBP), asymmetric oligoarthritis, enthesitis, and anterior uveitis, there are close associations with psoriasis and chronic inflammatory bowel disease (IBD).
The outcome is mainly influenced by the degree of disease activity over time and the loss of function and mobility, part of which is caused by inflammation, while the other part is due to new bone formation in the spine and structural damage of peripheral joints, the latter mainly in PsA. Male patients have more radiographic progression.
Non-steroidal anti-inflammatory agents (NSAIDs) are currently considered first choice of medical therapy. NSAIDs are widely used to ameliorate spinal pain but there is growing evidence that they may also inhibit syndesmophyte growth. There is a clear role for regular physiotherapy in AS to prevent loss of spinal mobility.
There are now 4 anti-TNF agents approved for the treatment of patients with active AS who have insufficiently responded to conventional therapies: infliximab, etanercept, adalimumab and golimumab. TNF blockers seem to have no influence on new bone formation in AS but they do inhibit radiographic damage in PsA. While the efficacy of anakinra, rituximab, abatacept, sarilumab and tocilizumab has not been convincingly shown in AS, the anti-IL-17a antibody secukinumab may work in this indication.
Disclosure of Interest None Declared