Treatment Guideline Chart
Spondyloarthritis refers to a group of chronic inflammatory rheumatic 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 is associated with at least one clinical criterion.

Ankylosing%20spondylitis Management

Follow Up

  • 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


  • 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
Editor's Recommendations
Special Reports