ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update

Five overarching principles and 15 recommendations focused on personalised medicine: eight unchanged, three with minor nomenclature edits, two with relevant updates (#9, 12), two newly formulated (#10, 11)

The first five recommendations: treatment target and monitoring, non-pharmacological management, and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment

Recommendations 6-8: analgesics; long-term GC and csDMARDs discouraged for pure axial involvement

#9: bDMARDs (tumour necrosis factor inhibitors (TNFi), IL-17i) and tsDMARDs (JAKi) for ASDAS ≥2.1 and failure of ≥2 NSAIDs plus elevated CRP, MRI inflammation of sacroiliac joints or radiographic sacroiliitis; current practice is to start a TNFi or IL-17i

#10: extramusculoskeletal manifestations: TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, IL-17i for significant psoriasis

#11: treatment failure should prompt re-evaluation of the diagnosis and consideration of comorbidities

#12: if active axial spondyloarthritis (axSpA) is confirmed, switching to another b/tsDMARD is recommended

#13: tapering, rather than immediate discontinuation, of a bDMARD can be considered in sustained remission

#14, 15: surgery and spinal fractures