@article{3103767,
    title = "Treatment strategies in axial spondyloarthritis: What, when and how?",
    author = "Fragoulis, G.E. and Siebert, S.",
    journal = "Rheumatology (United Kingdom)",
    year = "2020",
    volume = "59",
    pages = "IV79-IV89",
    publisher = "Oxford University Press",
    doi = "10.1093/rheumatology/keaa435",
    keywords = "biological product;  disease modifying antirheumatic drug;  interleukin 17;  nonsteroid antiinflammatory agent;  tumor necrosis factor;  antirheumatic agent;  cytokine;  Janus kinase inhibitor, Article;  biological therapy;  drug use;  human;  inflammation;  spine radiography;  spondylarthritis;  symptom;  treatment response;  disease exacerbation;  pathology;  spondylarthritis, Anti-Inflammatory Agents, Non-Steroidal;  Antirheumatic Agents;  Cytokines;  Disease Progression;  Humans;  Janus Kinase Inhibitors;  Spondylarthritis",
    abstract = "There have been major advances in the management of axial spondyloarthritis (axSpA) with the introduction of effective biologic agents targeting TNF and IL-17A. Clinicians now have more choice but, despite treatment recommendations, are still faced with significant uncertainty when deciding on the optimal treatment strategy for an individual patient in clinical practice. Management of axSpA typically requires both non-pharmacological and pharmacological interventions. NSAIDs remain the first line drug therapies for axSpA with proven efficacy for symptomatic management but uncertainty remains regarding their optimal long-term use relating to radiographic progression and safety in axSpA. To-date there are no head-to-head trials of biologics in axSpA. Clinicians need to consider other factors, including extra-articular manifestations, comorbidities, safety and radiographic progression when deciding on which biologic to recommend for an individual patient. This article will explore the evidence relating to these factors and highlight areas of unmet need. © 2020 The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology."
}