Treatment of ankylosing sondylitis

Abstract

Ankylosing spondylitis classified axial spondyloarthritis mainly affects axial joints, including sacroiliac joints and the spine. Inflammation in AS starts from entheses. It induces consequent bone erosions, and then new bone formation occurs and syndesmophytes slowly develops, resulting in bridging between vertebral bodies in the long disease duration. For early intervention of the disease, ASAS proposed classification criteria for axial spondyloarthritis. Under these criteria, non-radiographic axial SpA（nr-axSpA）can be classified, however, nr-axSpA does not always progress to AS. In the treatment of AS, physical therapy, such as stretching and swimming, is highly recommended. In active AS despite of NSAIDs, salazosulfapyridine can be used for peripheral arthritis, while methotrexate is generally ineffective. TNF inhibitors, infliximab and adalimumab, are used alongside NSAIDs. It is recommended to switch to another TNF inhibitor in the event of secondary failure to respond to TNF inhibitors and to switch to IL-17 inhibitors in the event of primary failure. Clinical trials of JAK inhibitors for AS are now ongoing.