CURRENT TRENDS IN AXIAL SPONDYLOARTHRITIS MANAGEMENT: A STATE-OF-THE-ART REVIEW OF TREATMENT OPTIONS
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the axial skeleton, leading to significant disability if left untreated. Over the past few decades, there have been significant advancements in the treatment options for axSpA, driven by a deeper understanding of its pathophysiology and the development of novel therapeutic agents. This review summarizes the state-of-the-art treatment strategies for axSpA, focusing on pharmacologic therapies, non-pharmacologic interventions, and emerging biological agents. The review also highlights the importance of a multidisciplinary approach in managing the disease. Current challenges, such as treatment access, patient compliance, and the long-term effects of treatment regimens, are also discussed. The evolving landscape of axSpA treatment suggests a promising future for patients, with enhanced therapeutic outcomes and quality of life.
Keywords
Axial spondyloarthritis, biologics, TNF inhibitorsHow to Cite
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Deodhar, A.; Strand, V.; Kay, J.; Braun, J. The term “non-radiographic axial spondyloarthritis” is much more important to classify than to diagnose patients with axial spondyloarthritis. Ann. Rheum. Dis. 2016, 75, 791–794. [Google Scholar] [CrossRef] [PubMed]
Ramiro, S.; Nikiphorou, E.; Spriano, A.; Ortolan, A.; Webers, C.; Baraliakos, X.; Landewé, R.B.; van der Heijde, D. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann. Rheum. Dis. 2023, 82, 19–34. [Google Scholar] [CrossRef] [PubMed]
Nikiphorou, E.; Baraliakos, X. Treat-to-target in axial spondyloarthritis. Rheum. Dis. Clin. N. Am. 2019, 45, 519–535. [Google Scholar] [CrossRef]
Dougados, M. Treat-to-target in axial spondyloarthritis: From its concept to its implementation. J. Autoimmun. 2020, 110, 102398. [Google Scholar] [CrossRef]
Rudwaleit, M.; van der Heijde, D.; Landewé, R.; Listing, J.; Akkoc, N.; Brandt, J.; Braun, J.; Chou, C.T.; Collantes-Estevez, E.; Dougados, M.; et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann. Rheum. Dis. 2009, 68, 777–783. [Google Scholar] [CrossRef] [PubMed]
Martey, C.; Sengupta, R. Physical therapy in axial spondyloarthritis: Guidelines, evidence and clinical practice. Curr. Opin. Rheumatol. 2020, 32, 365–370. [Google Scholar] [CrossRef]
Milner, J.R.; Barron, J.S.; Beinke, K.M.; Butterworth, R.H.; Chasle, B.E.; Dutton, L.J.; Lewington, M.A.; Lim, E.G.S.; Morley, T.B.; O’Reilly, J.E.; et al. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Semin. Arthritis Rheum. 2016, 45, 411–427. [Google Scholar] [CrossRef]
Gwinnutt, J.M.; Wieczorek, M.; Cavalli, G.; Balanescu, A.; Bischoff-Ferrari, H.A.; Boonen, A.; de Souza, S.; de Thurah, A.; Dorner, T.E.; Moe, R.H.; et al. Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): Systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022, 8, e002168. [Google Scholar] [CrossRef]
Danve, A.; Deodhar, A. Treatment of axial spondyloarthritis: An update. Nat. Rev. Rheumatol. 2022, 18, 205–216. [Google Scholar] [CrossRef]
Navarro-Compán, V.; Sepriano, A.; El-Zorkany, B.; van der Heijde, D. Axial spondyloarthritis. Ann. Rheum. Dis. 2021, 80, 1511–1521. [Google Scholar] [CrossRef]
Ward, M.M.; Deodhar, A.; Gensler, L.S.; Dubreuil, M.; Yu, D.; Khan, M.A.; Haroon, N.; Borenstein, D.; Wang, R.; Biehl, A.; et al. 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of Ankylosing spondylitis and Nonradiographic axial spondyloarthritis. Arthritis Care Res. 2019, 71, 1285–1299. [Google Scholar] [CrossRef] [PubMed]
Andreu, J.L.; Otón, T.; Sanz, J. Anti-TNF alpha therapy in ankylosing spondylitis: Symptom control and structural damage modification. Reumatol. Clin. 2011, 7, 51–55. [Google Scholar] [CrossRef]
Neerinckx, B.; Lories, R.J. Structural disease progression in axial spondyloarthritis: Still a cause for concern. Curr. Rheumatol. Rep. 2017, 19, 14. [Google Scholar] [CrossRef]
Kocijan, R.; Muschitz, C.; Rech, J. Anti-TNFs in axial spondyloarthritis. Wien. Med. Wochenschr. 2015, 165, 10–13. [Google Scholar] [CrossRef]
Molto, A.; López-Medina, C.; van den Bosch, F.E.; Booren, A.; Webers, C.; Dernis, E.; van Gaalen, F.A.; Soubrier, M.; Claudepierre, P.; Baillet, A.; et al. Efficacy of a tight-control and treat-to-target strategy in axial spondyloarthritis: Results of the open-label, pragmatic, cluster-randomised TICOSPA trial. Ann. Rheum. Dis. 2021, 80, 1436–1444. [Google Scholar] [CrossRef] [PubMed]
Danve, A.; Deodhar, A. Treat-to-target in Axial Spondyloarthritis. What are the issues? Curr. Rheumatol. Rep. 2017, 19, 22. [Google Scholar] [CrossRef] [PubMed]
Ritchlin, C.; Adamopoulos, I.E. Axial spondyloarthritis: New advances in diagnosis and management. BMJ 2021, 372, m4447. [Google Scholar] [CrossRef] [PubMed]
Pécourneau, V.; Degboé, Y.; Barnetche, T.; Cantagrel, A.; Constantin, A.; Ruyssen-Witrand, A. Effectiveness of exercise programs in ankylosing Spondylitis: A meta-analysis of randomized controlled trials. Arch. Phys. Med. Rehabil. 2018, 99, 383–389.e1. [Google Scholar] [CrossRef]
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