Treatment: Ankylosing Spondylitis

• Exercise program to maintain posture and mobility is important.
• NSAIDs first-line treatment, useful in most pts.
• TNF-modulatory agents (etanercept, infliximab, adalimumab, golimumab, certolizumab pegol) have been found to improve disease activity and function and reduce bone marrow edema on MRI. Generally used in active disease with failure of at least two NSAIDs.
• Secukinumab, an IL-17A antagonist, has been found to reduce signs and symptoms of active disease.

  Sulfasalazine 2-3 g/d is of modest benefit, primarily for peripheral arthritis.

• Methotrexate, widely used but has not been of proven benefit.
• No documented therapeutic role for systemic glucocorticoids.
• Intra-articular glucocorticoids for persistent enthesitis or peripheral synovitis; ocular glucocorticoids for uveitis with systemic immunosuppression required in some cases; surgery for severely affected or deformed joints.

For a more detailed discussion, see Taurog JD, Carter JD: The Spondyloarthritides, Chap. 384, p. 2169, in HPIM-19.