Pharmacological management of axial spondyloarthritis in adults

ABSTRACT

Introduction: Spondyloarthritis (SpA) refers to a group of disorders sharing common clinical, genetic and imaging characteristics. Axial (ax) SpA corresponds to a subgroup that mainly affects the axial skeleton, leading to inflammatory back pain and progressive radiographic changes of the sacroiliac joints and the spine. axSpA are currently subdivided into two forms, namely the radiographic and nonradiographic form, and are associated with musculoskeletal pain, restriction of spinal mobility, specific extra-articular features and overall, altered quality of life. The therapeutic management of axSpA has considerably progressed and is now well standardized.

Areas covered: Herein, the author reviews the pharmacological treatments that may be used in axSpA, including radiographic and nonradiographic forms in addition to the role of nonsteroidal anti-inflammatory drugs (NSAIDs), TNF alpha (TNFi), and IL-17A (IL-17Ai) inhibitors.

Expert opinion: NSAIDs remain the mainstay of initial therapy and biological agents may be then envisaged. TNFi and IL-17Ai may be used in axSpA, but physicians have more experience with TNFi. Only TNFi are licensed for the treatment of nonradiographic axSpA. IL-17Ai may be used as first or second line biologic disease modifying antirheumatic drugs (bDMARDs) and further results are needed to better define their position in the therapeutic management of axSpA.

KEYWORDS:

• Axial spondyloarthritis
• TNF inhibitors
• IL-17 inhibitors
• NSAIDs

Article highlights

• Ax SpA corresponds to a group of inflammatory rheumatic diseases that mainly affects the axial skeleton.

• pharmacological treatments of axSpA included NSAIDs and biological agents while convetionnal synthetic DMARDs are poorly effective.

• NSAIDs remain the mainstay of initial therapy in axSpA in both radiographic (r-axSpA) and non radiographic (nr-axSpA) forms of the disease.

• biological agents that are licensed for the treatment of r-axSpA are TNF inhibitors (TNFi) and IL-17A inhibitors. Only TNFi may be currently used in nr-axSpA

• Janus Kinase (JAK) inhibitors are currently evaluated in axSpA.

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Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.