Fast Five Quiz: Spine Pain

Herbert S. Diamond, MD

Disclosures

May 16, 2019

Guidelines on treatment for ankylosing spondylitis and nonradiographic axial spondyloarthritis have been issued by the American College of Rheumatology and include the following for adults with active ankylosing spondylitis:

  • 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

The following is recommended in adults with active ankylosing spondylitis despite treatment with NSAIDs:

  • Conditionally recommend against treatment with SAARDs

  • 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 ankylosing spondylitis despite treatment with NSAIDs and who have contraindications to TNFi, conditionally recommend treatment with a SAARD over treatment with a non-TNFi biologic agent

The following is recommended in adults with ankylosing spondylitis and inflammatory bowel disease:

  • 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:

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

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

Read more about the treatment of ankylosing spondylitis.

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