Ramiro, SofiaRamiro, SofiaNikiphorou, ElenaSepriano, AlexandreSepriano, AlexandreOrtolan, AugustaWebers, CasperBaraliakos, XenofonLandewé, Robert B.M.Van Den Bosch, Filip E.Boteva, BoryanaBremander, AnnCarron, PhilippeCiurea, AdrianVan Gaalen, Floris A.Géher, PálGensler, LianneHermann, JosefDe Hooge, ManoukHusakova, MarketaKiltz, UtaLópez-Medina, ClementinaMachado, Pedro M.Marzo-Ortega, HelenaMolto, AnnaNavarro-Compán, VictoriaNissen, Michael J.Pimentel-Santos, Fernando M.M. Pimentel-Santos, F.Poddubnyy, DenisProft, FabianRudwaleit, MartinTelkman, MarkZhao, Sizheng StevenZiade, NellyVan Der Heijde, Désirée2023-01-112023-01-112022-10-210003-4967PURE: 47973281PURE UUID: 150329fa-9b4b-4bd0-bcc2-79f44ee0ca47Scopus: 85142060542PubMed: 36270658WOS: 000872150900001http://hdl.handle.net/10362/147366Funding EULAR and Assessment of SpondyloArthritis international Society (ASAS).Objectives: To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). Methods: Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. Results: Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6-8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. Conclusions: The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.1818463engBiological TherapySpondyloarthritisTherapeuticsRheumatologyImmunology and AllergyImmunologyGeneral Biochemistry,Genetics and Molecular Biologyjournal article10.1136/ard-2022-223296https://www.scopus.com/pages/publications/85142060542