Fast Five Quiz: Joint Pain

Herbert S. Diamond, MD

Disclosures

February 12, 2019

Guidelines on treatment for AS and nonradiographic axial spondyloarthritis have been issued by the ACR. In adults with active AS, the following is recommended:

  • Strongly recommend treatment with NSAIDs over no treatment with NSAIDs

  • Conditionally recommend continuous treatment with NSAIDs over on-demand treatment with NSAIDs

  • No recommendation for any particular NSAID as the preferred choice

  • Strongly recommend against treatment with systemic glucocorticoids

In adults with active AS despite treatment with NSAIDs, the following is recommended:

  • Conditionally recommend against treatment with slow-acting antirheumatic drugs

  • Strongly recommend treatment with a TNFi over no treatment with TNFi

  • No recommendation for any particular TNFi as the preferred choice

  • In adults with active AS despite treatment with NSAIDs, and who have contraindications to TNFi, conditionally recommend treatment with a slow-acting antirheumatic drug over treatment with a non-TNFi biologic agent

In adults with AS and inflammatory bowel disease, the following is recommended:

  • No recommendation for any particular NSAID as the preferred choice to decrease the risk of worsening of inflammatory bowel disease symptoms

  • Treatment with TNFi monoclonal antibodies strongly recommended over treatment with etanercept

Other recommendations include the following:

  • In adults with AS and isolated active sacroiliitis despite treatment with NSAIDs, conditionally recommend treatment with locally administered parenteral glucocorticoids over no treatment with local glucocorticoids.

  • In adults with AS with stable axial disease and active enthesitis despite treatment with NSAIDs, conditionally recommend using treatment with locally administered parenteral glucocorticoids over no treatment with local glucocorticoids. Peri-tendon injections of Achilles, patellar, and quadriceps tendons should be avoided.

  • In adults with AS with stable axial disease and active peripheral arthritis despite treatment with NSAIDs, conditionally recommend using treatment with locally administered parenteral glucocorticoids over no treatment with local glucocorticoids.

  • In adults with AS and advanced hip arthritis, strongly recommend treatment with total hip arthroplasty over no surgery.

  • In adults with AS and severe kyphosis, conditionally recommend against elective spinal osteotomy.

Read more information about the treatment of AS.

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