Ramiro, SofiaNikiphorou, ElenaSepriano, AlexandreOrtolan, AugustaWebers, CasperBaraliakos, XenofonLandewe, Robert B MVan den Bosch, Filip EBoteva, BoryanaBremander, AnnCarron, PhilippeCiurea, Adrianvan Gaalen, Floris AGeher, PalGensler, LianneHermann, Josefde Hooge, ManoukHusakova, MarketaKiltz, UtaLopez-Medina, ClementinaMachado, Pedro MMarzo-Ortega, HelenaMolto, AnnaNavarro-Compan, VictoriaNissen, Michael JPimentel-Santos, Fernando MPoddubnyy, DenisProft, FabianRudwaleit, MartinTelkman, MarkZhao, Sizheng StevenZiade, Nellyvan der Heijde, Desiree2023-05-032023-05-032022-10-04Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2023 Jan;82(1):19-34http://hdl.handle.net/10668/20132To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6-8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.enBiological therapySpondyloarthritisTherapeuticsHumansAntirheumatic agentsAnti-inflammatory agents, non-steroidalSpondylarthritisSpondylitis, ankylosingAnalgesicsresearch article36270658open accessAnalgésicosAntiinflamatorios no esteroideosAntirreumáticosEspondilitis anquilosanteEspondiloartritis10.1136/ard-2022-2232961468-2060https://ard.bmj.com/content/annrheumdis/82/1/19.full.pdf