This protocol applies to patients with ankylosing spondylitis who have already undergone a switch to another biologic DMARD or JAK inhibitor, yet have not reached the required level of disease activity improvement. At this stage, a defined next-line approach is warranted.
A switch to another bDMARD (TNFi or IL-17A inhibitor) or Janus kinase inhibitor was carried out. After at least 12 weeks, clinically important improvement in ASDAS — defined as a decrease of ≥1.1 — was not achieved. This failure to meet the target triggers escalation to this next-line protocol.
When pharmacological options have been exhausted, a surgical intervention may be considered in carefully selected patients presenting with specific structural criteria. The complete decision framework, indications, and conditions are detailed in the full protocol.
DOI: 10.1136/ard-2022-223296
Total hip arthroplasty should be considered in patients with refractory pain or disability and radiographic evidence of structural damage, independent of age; spinal corrective osteotomy in specialised centres may be considered in patients with severe disabling deformity.