Ankylosing spondylitis
ICD-10 M45 · ICD-11 FA92.0Z

Treatment of Ankylosing Spondylitis with Recurrent Anterior Uveitis or Active Inflammatory Bowel Disease

Clinical scenario

This protocol addresses patients with ankylosing spondylitis (axial spondyloarthritis) who have a concurrent or historical diagnosis of recurrent anterior uveitis or active inflammatory bowel disease (IBD). The presence of these extramusculoskeletal manifestations shapes the therapeutic approach.

The choice of pharmacological therapy is directly influenced by the comorbidity: active IBD places specific restrictions on certain drug classes, and a history of recurrent uveitis or active IBD guides the preferred class of biological agent when escalation is needed.
First-line approach (overview — partial)

Initial management centres on NSAID therapy used up to the maximum tolerated dose, combined with structured non-pharmacological measures — including patient education about axSpA, regular exercise, physiotherapy, and smoking cessation. Continuous NSAID use may be indicated in those who respond and continue to need symptom control.

The complete regimen, sequencing, comorbidity-specific restrictions, and escalation criteria are detailed in the full protocol.

Treatment targets

The primary goal at 2–4 weeks is control of back pain and spinal stiffness. By reducing inflammation, first-line therapy aims to keep disease activity and symptoms manageable within this early window.

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References

  1. If there is a history of recurrent uveitis or active IBD, preference should be given to a monoclonal antibody against TNF.
  2. In patients with active IBD, IL-17i are contraindicated.
  3. Patients suffering from pain and stiffness should use an NSAID as first-line drug treatment up to the maximum dose, taking risks and benefits into account.
  4. For patients who respond well to NSAIDs, continuous use is preferred if needed to control symptoms.
  5. Patients should be educated about axSpA and encouraged to exercise on a regular basis and stop smoking; physiotherapy should be considered.
  6. By suppressing inflammation, NSAIDs often suffice in keeping disease activity and symptoms under control.

DOI: 10.1136/ard-2022-223296

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