Ankylosing Spondylitis with Significant Psoriasis: What to Do When bDMARD and JAK Inhibitor Therapy Has Failed
This protocol applies to patients with ankylosing spondylitis and significant psoriasis who have not achieved an adequate response after being switched to another biologic DMARD or Janus kinase inhibitor. It outlines the structured next step when that treatment line falls short.
Clinical scenario
The patient has ankylosing spondylitis in the setting of significant psoriasis. The coexisting skin condition is a key factor in treatment selection at every line of management.
Previous treatment — insufficient response
The prior step involved switching to another biologic DMARD — either a TNF inhibitor or an IL-17A inhibitor — or to a Janus kinase inhibitor. This protocol is reached when that regimen did not achieve a clinically important improvement in disease activity (ASDAS decrease of at least 1.1) after at least 12 weeks of treatment.
Next step — partial overview
For patients who have not responded to prior lines of therapy, this protocol specifies selected surgical options that may be considered in appropriate candidates with refractory symptoms and confirmed structural changes. The full eligibility criteria, specific procedures, centre requirements, and decision pathway are available in the complete protocol.
References
DOI: 10.1136/ard-2022-223296
- In patients with significant psoriasis, an IL-17i may be preferred.
- 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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