Treatment Guideline Chart
Spondyloarthritis refers to a group of inflammatory diseases characterized by spinal & joint oligoarthritis, enthesitis, and sometimes mucocutaneous, ocular and/or cardiac manifestations.
Ankylosing spondylitis is a prototype of spondyloarthritis, particularly of the axial form.
Diagnosis of ankylosing spondylitis is definite if any of the radiological criterion (grade≥2 bilateral sacroiliitis or grade ≥3 unilateral sacroiliitis) is associated with at least one of the clinical criterion (low back pain & stiffness for >3 months that improves with exercise but not relieved by rest, limitation of motion of the lumbar spine in the sagittal and frontal planes, limitation of chest expansion relative to normal values correlated for age and gender.

Ankylosing%20spondylitis Management

Follow Up

  • Follow-up schedule depends on the patient’s disease activity
    • Annual clinic visits is recommended for patients with stable AS
  • At least 1 assessment tool should be used during clinic visits, depending on the disease activity
    • Erythrocyte sedimentation rate or C-reactive protein monitoring at regular intervals is recommended
    • Dual x-ray absorptiometry (DXA) 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
  • Referral to an ophthalmologist is recommended for AS patients with acute iritis


  • For patients with stable AS given combination therapy with NSAIDs and TNF inhibitor upon diagnosis, patients may continue using tumor necrosis factor 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
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