Treatment of Ankylosing Spondylitis in Patients with Significant Psoriasis
Clinical Scenario
This protocol addresses ankylosing spondylitis (axial spondyloarthritis, axSpA) in patients who also have significant psoriasis. The presence of this comorbidity directly influences treatment selection and must be accounted for when planning management.
Significant psoriasis is a recognised factor that shapes the choice of therapy in ankylosing spondylitis — including which agents may be preferred over others.
Clinical Goals
The primary targets for this first-line protocol are control of back pain and spinal stiffness, with response assessed at 2–4 weeks from treatment initiation.
Treatment Approach — Partial Overview
First-line management combines an anti-inflammatory agent — used at the maximum tolerated dose — with a structured programme of non-pharmacological measures. The complete protocol specifies drug selection considerations that are directly relevant to patients with significant psoriasis, together with the full algorithm and supporting interventions.
References
DOI: 10.1136/ard-2022-223296
- In patients with significant psoriasis, an IL-17i may be preferred.
- 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.
- For patients who respond well to NSAIDs, continuous use is preferred if needed to control symptoms.
- Patients should be educated about axSpA and encouraged to exercise on a regular basis and stop smoking; physiotherapy should be considered.
- By suppressing inflammation, NSAIDs often suffice in keeping disease activity and symptoms under control.
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