Management Lines of Ankylosing Spondylitis: Updated Overview

Abstract

Background: Ankylosing spondylitis (AS) is the chief subtype and a leading outcome of an inter-related cluster of rheumatic disorders named spondyloarthritides (SpAs). Clinical features of this cluster encompass inflammatory back pain, asymmetrical peripheral oligoarthritis (primarily of the lower limbs), enthesitis, and specific organ involvement like anterior uveitis. Aortic root involvement and conduction abnormalities are uncommon complications of ankylosing spondylitis. This disease may lead to structural and functional disorders. In contrast to the synovial membrane inflammation associated with many other arthropathies, such as rheumatoid arthritis (RA), the typical pathology of AS is enthesitis. The entheses are anatomical locations that tolerate heavy mechanical loads, such as fibrocartilaginous joints, the osseous insertions of ligaments and tendons, and joint capsules. The American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network (ACR/SAA/SPARTAN) guidelines 2019 updates advise that the objectives of axSpA/AS management are: to relieve symptoms, enhance functioning, sustain workability, reduce disease complications, and diminish skeletal damage. NSAIDs and proper rehabilitation programs remain the mainstays of the management of axSpA. The 2016 update of the Assessment of Spondylarthritis International Society (ASAS) and European League Against Rheumatism (EULAR) guidelines advise that patients with pain and stiffness should utilize an NSAID as a first-line treatment up to the full dose while considering hazards and benefits. For patients who improve on NSAIDs, continued use of this medication is favored if on-demand use worsens symptom.