Personalized Axial Spondyloarthritis Care

Abstract

Purpose of review

To discuss the personalized care of patients with axial spondyloarthritis.

Recent findings

Secukinumab, an IL-17A inhibitor, has recently been proven to be effective in treating signs and symptoms of ankylosing spondylitis. The latest update of ASAS/EULAR management recommendations include secukinumab and recommend a personalized medicine approach for the treatment of patients with axial spondyloarthritis.

Summary

Nonsteroidal anti-inflammatory drugs benefit a significant proportion of patients with axial spondyloarthritis. Conventional disease-modifying anti-rheumatic drugs are not effective for axial symptoms. Sulfasalazine may have limited efficacy for peripheral articular symptoms, but not for enthesitis. Local glucocorticoid injections may be helpful for joint and entheseal inflammation. Patients failing to respond to conventional treatments can be treated with biologics inhibiting TNF-α and IL-17A. They all have a similar efficacy for the treatment of axial and peripheral disease but vary in their efficacy on the extra-articular disease manifestations and safety profiles. TNF-α inhibitors are recommended over secukinumab as the initial choice for biologic treatment, due to the availability of larger amount of data, as well as longer and greater clinical experience with these agents. Molecular and genomic biomarkers which are central and crucial to implementation of personalized medicine in its modern context are not yet available for the treatment of axial spondyloarthritis; therefore, personalized care of such patients can currently be practiced mainly on the basis of general patient characteristics, patient preferences, and clinical findings.

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