Ankylosing Spondylitis with Recurrent Anterior Uveitis or Active Inflammatory Bowel Disease — After bDMARD or JAK Inhibitor Failure

This protocol applies to patients with ankylosing spondylitis who also have recurrent anterior uveitis or active inflammatory bowel disease, and whose previous biologic or targeted synthetic therapy failed to reach the required disease-activity target.

Clinical Scenario

The patient has ankylosing spondylitis alongside recurrent anterior uveitis or active inflammatory bowel disease. These comorbidities carry direct implications for which treatments are appropriate and which are contraindicated.

Previous Treatment — Target Not Reached

A switch to another bDMARD (TNF inhibitor or IL-17A inhibitor) or a Janus kinase inhibitor did not achieve a clinically important improvement in ASDAS — defined as a decrease of ≥1.1 — after at least 12 weeks of treatment. This failure is the trigger for escalation to the current management step.

Next Step — Partial Overview

The next management step centres on surgical evaluation for patients who remain refractory and show evidence of structural damage. The full protocol specifies the precise indications, patient-selection criteria, and clinical decision pathway — the complete regimen is required to guide management.

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.
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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