New recommendations for the treatment of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (SpA) have recently been released by the American College of Rheumatology, in conjunction with the Spondylitis Association of America (SAA) and the Spondyloarthritis Research and Treatment Network. Included are both pharmacologic and nonpharmacologic treatment alternatives, as well as guidance on patient monitoring, surgical options, and management of patients with comorbid conditions. Ankylosing spondylitis affects up to .05% of the adult population, occurring most frequently in men in their teens and 20’s. The condition results in abnormal bone fusion, and causes pain and stiffness in the lower back, hips and buttocks. Fusion of the ribs to either the spine or breastbone may additionally impair breathing ability.
The newly released guideline is described by principal investigator Michael Ward, MD, MPH, as providing “…a foundation based on the current best-available evidence.” It was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach – a system recognized for transparency and for rating both the quality of available evidence and the strength of recommendations made. Five categories of recommendations are offered, covering patients with either active or stable AS, patients with non-radiographic axial SpA, and patients with additional comorbidities including advanced hip arthritis, severe kyphosis, acute iritis, and inflammatory bowel disease. A news story, with link to the complete recommendations, may be read here.