Ankylosing Spondylitis with Peripheral Arthritis: What to Do When bDMARD or JAK Inhibitor Therapy Has Not Achieved Adequate Response

Clinical Scenario

This protocol addresses patients with ankylosing spondylitis who have peripheral arthritis and whose prior biologic or targeted synthetic DMARD therapy has not achieved the expected treatment response. Peripheral involvement shapes both the treatment goals and the escalation pathway.

Prior Treatment Line — Insufficient Response

The previous therapy — switch to another bDMARD (TNFi or IL-17A inhibitor) or Janus kinase inhibitor — did not achieve a clinically important ASDAS improvement (decrease ≥1.1) after at least 12 weeks. Failure to reach this target at the prior line is the clinical trigger for escalation to the current protocol.

Next-Line Approach — Partial Overview

At this stage, surgical management is among the approaches considered for patients with refractory pain or disability when there is radiographic evidence of structural damage.

The complete protocol — covering the full range of interventions, applicable conditions, and clinical sequencing — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1136/ard-2022-223296

Patients with purely axial disease should normally not be treated with csDMARDs; sulfasalazine may be considered in patients with peripheral arthritis.

In patients with predominantly peripheral manifestations, following recommendations 7 and 8, failure to treatment includes one glucocorticoid injection, if appropriate, and the use of sulfasalazine.

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.

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