New Diagnostic Criteria for Axial Spondylarthritis

Exercise, including physical therapy, improves function and decreases pain. Dr. Khan recommended swimming as the best exercise for SpA patients. The exercise should not be short-term but rather the beginning of a lifelong exercise program, which is necessary in the management of a chronic condition.

ASAS recommendations on managing SpA suggest using anti-TNF agents in patients with SpA, but only after:

• A regimen of NSAIDs (at least two different drugs tried for one month or more total);
• An adequate therapeutic trial of a disease-modifying antirheumatic drug (DMARD), preferably sulfasalazine, for patients with peripheral symptoms; and
• An efficacy evaluation of the above steps after 12 weeks.⁶

Note that patients with axial spondylarthritis do not need to take a DMARD before or concomitant with an anti-TNF agent.

All TNF inhibitors are remarkably effective as monotherapy for treating SpA, and the response is even better in early disease. TNF inhibitors have long-term efficacy and an acceptable safety profile, but there is a need for adequate intake of vitamin D and calcium and for ongoing screening for concomitant osteopenia and osteoporosis.

Ann Kepler is a medical journalist based in Chicago.

References

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