ABSTRACT

Axial spondyloarthritis (axSpA) is a complex disease that characterised predominately by inflammation of the axial skeleton with subsequent symptoms of chronic back pain and sacroiliitis. In the recent years, there has been significant progress in earlier detection of the molecular mechanisms involved in its pathogenesis. This is important in terms of increasing treatment options. The addition of anti-tumor necrosis factor (TNF) to the treatment of axSpA patients initially treated with non-steroidal anti-inflammatory drugs (NSAIDs) and exercise, revolutionized the treatment of axSpA. Over the last few years, the use of interleukin (IL)-17 inhibitors in the treatment of axSpA has begun to expand treatment options. In this article, we review the current pharmacological and non-pharmacological therapies for axSpA, the emergence of biosimilars, treatment in advanced ankylosing spondylitis, drug use during pregnancy, the effect of orthopedic surgery and morbidity. Disease management of each SpA patient should be determined individually. Smoking cessation, exercise and training are common recommendations. NSAIDs, which are the first step in pharmacological treatment, should be used in effective doses as standard, although bDMARDs are considered in patients whose disease activity is not controlled with NSAIDs. Both TNF inhibitors (including biosimilars) and IL-17 inhibitor secukinumab have been shown to be efficacious in clinical trials. Biosimilars have provided a more affordable option within this growing therapeutic area. Some patients may require hip or spinal orthopedic surgery. During the follow-up of all patients, morbidity such as atherosclerosis and hypertension should be considered.