AS and nr-axSpA treatment aims to reduce disease activity, improve QoL and preserve the functional abilities of patients.
First-line therapy is often represented by NSAIDs and low-dosage CS (oral and intra-articular administration). cDMARDs (MTX and SSZ) have shown poor efficacy in the treatment of patients with peripheral joint disease. TNFα-inhibitor treatment is currently the only effective therapy for patients with axial SpA in whom conventional therapy with NSAIDs and cDMARDs has failed. Even though TNFα-inhibitors have proven effective in the treatment of SpA, there is an unmet clinical need for new therapies that have alternative mechanisms of action for these diseases, owing to an increasing number of non-responder patients or patients with contraindications to TNFα-inhibitor therapy. Among the newer therapies studied to date, targeting IL-17, IL-12/IL-23 and PDE4, appear to show more promise than therapies targeting T-cell co-stimulation, B-cell surface antigens and IL-6 (’Table 1: Biological treatment for ankylosing spondilitis and non-radiographic axial spondyloarthritis’).