Ankylosing%20spondylitis Management

• Disease monitoring should include patient-reported outcomes, clinical findings, laboratory tests and imaging, with frequency of monitoring decided on an individual basis depending on symptom, severity and treatment
• Follow-up schedule depends on the patient’s disease activity
  • Annual clinic visits are recommended for patients with stable AS
• At least one assessment tool should be used during clinic visits, depending on the disease activity
  • ESR or CRP monitoring at regular intervals is recommended
  • Dual X-ray absorptiometry scanning of the spine and hips may be considered for patients at high risk for osteoporosis or osteopenia and in patients with syndesmophytes or spinal fusion
  • Lack of response to treatment should prompt re-evaluation of the diagnosis and presence of possible comorbidities (eg fibromyalgia, depression, osteoarthritis)
• Referral to an ophthalmologist is recommended for AS patients with acute uveitis

Management

• For patients with stable AS given combination therapy with NSAIDs and TNF inhibitor upon diagnosis, patients may continue using TNF inhibitor alone as maintenance therapy
  • May reduce dose or increase intervals if remission is maintained and after discussion with the patient
• Any change in the course of AS (eg spinal fracture) should prompt further investigation especially imaging studies