Management for axial spondyloarthritis
The goal of axial spondyloarthritis management is to maximise long-term health-related quality of life by:
- controlling symptoms and inflammation
- normalising physical function
- enabling participation in social and work-related activities
- preventing progressive structural damage
- minimising cardiovascular complications.
Nonpharmacological management of axial spondyloarthritis should be included as part of a multidimensional approach to pain management, especially in those who experience persistent pain. Not all pain experienced by patients with axial spondyloarthritis is inflammatory pain, consider mechanical and neuropathic contributors to pain if the inflammatory process is well controlled. Nonpharmacological management may include; physical activity, use of psychological techniques, finding opportunities for social connection, and if applicable, advice on how to stop tobacco smoking.
At diagnosis, it is important to encourage participation in a long-term exercise program and to introduce coping strategies to address possible psychosocial impacts of the disease. An integrated sociopsychobiomedical approach is recommended to address issues such as workforce participation, socialisation, sexual function and sleep. Printed or online information is useful for providing ongoing education1.
In combination with exercise, nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapy for the management of pain and inflammation in axial spondyloarthritis.
When treatment with the combination of exercise and an NSAID is inadequate to control symptoms, or disease is severe, immunomodulatory therapy is added. The choice of drug depends on the site of disease activity.
In general biological or targeted-synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) are preferred in patients with active spondyloarthritis that has not responded to NSAIDs, because they are effective in the treatment of both axial inflammation and axial and peripheral enthesitis.
Local corticosteroid injections may be used for persistent localised symptoms of peripheral arthritis or enthesitis.
Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and oral corticosteroids have a limited role in the treatment of axial spondyloarthritis because they have no effect on axial inflammation or enthesitis. They may occasionally be used by specialists in patients with predominantly peripheral arthritis.