Internal medicine

Tumor necrosis factor alpha

Ankylosing spondylitis

Intensive care medicine

Physical therapy

Axial spondyloarthritis

Sacroiliitis

Etanercept

Clinical trial

Medicine

Nature Reviews Rheumatology

Diagnosis and management of axial spondyloarthritis (axSpA) has vastly improved over the past two decades. With advances in the discernment of immunopathogenesis of this disease, new therapies have become available, which are associated with substantial improvement in symptoms, signs and quality of life. The four broad categories of approved treatment options are physical therapy and exercise (which have been known to be beneficial for millennia), NSAIDs (since the 1950s), TNF inhibitors (first FDA approval in 2003) and IL-17 inhibitors (first FDA approval in 2016). In addition, there have been a host of new developments in the axSpA field, including new treatment guidelines, the FDA approval of three biologic DMARDs to treat non-radiographic axSpA, the FDA and EMA approval of Janus kinase (JAK) inhibitors for ankylosing spondylitis, new data on the effect of biologic DMARDs on structural progression in ankylosing spondylitis, strategy trials on tapering or stopping TNF inhibitors in patients in remission, trials of treat-to-target strategy in axSpA, and several new molecules in phase III studies. This Review explores the developments in the management of axSpA. Axial spondyloarthritis, an immune-mediated inflammatory disease, is characterized by chronic back pain, joint stiffness and fatigue that can severely affect the quality of life. This Review summarizes the progress in the pharmacological management of this disease, including newly approved biologic DMARDs.

Treatment of axial spondyloarthritis: an update