What are the American College of Rheumatology treatment guidelines for active nonradiographic axial spondyloarthritis (SpA) despite treatment with NSAIDs?

Updated: Feb 02, 2021
  • Author: Lawrence H Brent, MD; Chief Editor: Herbert S Diamond, MD  more...
  • Print
Answer

In adults with active nonradiographic axial SpA despite treatment with NSAIDs​:

  • Conditionally recommend treatment with sulfasalazine, methotrexate, or tofacitinib over no treatment with these medications
  • Strongly recommend treatment with TNFi over no treatment with TNFi
  • Do not recommend any particular TNFi as the preferred choice
  • Conditionally recommend treatment with TNFi over treatment with tofacitinib
  • Conditionally recommend treatment with secukinumab or ixekizumab over no treatment with secukinumab or ixekizumab
  • Conditionally recommend treatment with TNFi over treatment with secukinumab or ixekizumab
  • Conditionally recommend treatment with secukinumab or ixekizumab over treatment with tofacitinib
  • In patients who have contraindications to TNFi, conditionally recommend treatment with secukinumab or ixekizumab over treatment with sulfasalazine, methotrexate, or tofacitinib
  • In adults with active nonradiographic axial SpA and primary nonresponse to the first TNFi used, conditionally recommend switching to secukinumab or ixekizumab over switching to a different TNFi.
  • In adults with active nonradiographic axial SpA and secondary nonresponse to the first TNFi used, conditionally recommend switching to a different TNFi over switching to a non-TNFi biologic.
  • In adults with active nonradiographic axial SpA despite treatment with the first TNFi used, strongly recommend against switching to the biosimilar of the first TNFi.
  • In adults with active nonradiographic axial SpA despite treatment with the first TNFi used, conditionally recommend against the addition of sulfasalazine or methotrexate in favor of treatment with a different biologic.

Other recommendations for adults with nonradiographic axial SpA:

  • Strongly recommend against treatment with systemic glucocorticoids
  • In patients with isolated active sacroiliitis despite treatment with NSAIDs, conditionally recommend treatment with local glucocorticoids over no treatment with local glucocorticoids
  • In patients with active enthesitis despite treatment with NSAIDs, conditionally recommend using treatment with locally administered parenteral glucocorticoids over no treatment with local glucocorticoid; however, peri-tendon injections of Achilles, patellar, and quadriceps tendons should be avoided
  • In patients with active peripheral arthritis despite treatment with NSAIDs, conditionally recommend using treatment with locally administered parenteral glucocorticoids over no treatment with local glucocorticoids
  • Strongly recommend treatment with physical therapy over no treatment with physical therapy
  • Conditionally recommend active physical therapy interventions (supervised exercise) over passive physical therapy interventions (massage, ultrasound, heat)
  • Conditionally recommend land-based physical therapy interventions over aquatic therapy interventions

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!