Ankylosing Spondylitis with Recurrent Anterior Uveitis or Active Inflammatory Bowel Disease After NSAID Failure

Clinical Scenario

This protocol addresses patients with ankylosing spondylitis who have recurrent anterior uveitis or active inflammatory bowel disease — comorbidities that directly shape which treatments are appropriate.

Previous Treatment Line — Inadequate Response

First-line management included NSAIDs at the maximum tolerated dose, used continuously as needed, together with patient education about axial spondyloarthropathy, regular exercise, smoking cessation, and physiotherapy. This approach did not achieve the target of controlling back pain and spinal stiffness within 2–4 weeks.

Next-Line Treatment Approach (partial)

Because of the comorbid uveitis or active IBD, treatment is guided toward a specific class of biologic — a monoclonal antibody against TNF. The full protocol specifies which agents are indicated and what the complete regimen involves.

Treatment goals: clinically important improvement in disease activity assessed after at least 12 weeks, and prevention of uveitis recurrence.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1136/ard-2022-223296

If there is a history of recurrent uveitis or active IBD, preference should be given to a monoclonal antibody against TNF.

In patients with active IBD, IL-17i are contraindicated.

In patients with previous uveitis, monoclonal antibodies against TNF (infliximab, adalimumab, certolizumab pegol, golimumab) have been shown to be efficacious in preventing the recurrence of uveitis, whereas etanercept showed contradictory results.

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