What Do axSpA Treatment Guidelines Mean for People Living with axSpA?

Image of a hand writing: Treatment Guidelines

Two important sets of treatment guidelines are shaping care for axSpA: the ASAS-EULAR recommendations, published in Annals of the Rheumatic Diseases in 2023, and the 2025 guideline from the British Society for Rheumatology (BSR). The ASAS-EULAR recommendations provide international guidance on managing axSpA, while the BSR guideline focuses specifically on the use of biologic and targeted synthetic disease-modifying anti-rheumatic drugs, known as b-DMARDs and tsDMARDs, in adults with axSpA. It does not cover all aspects of axSpA care, but sits alongside broader guidance on overall disease management.¹˒²

Developed through expert review processes involving clinicians, researchers and patients, these evidence-based recommendations are designed to guide treatment decisions and improve standards of care. For patient organisations, they are useful not only as clinical documents, but as tools for advocacy, education and identifying gaps in care.¹˒²

The guidelines reflect significant advances in understanding axSpA and the growing number of treatment options now available. Importantly, they emphasise that treatment is not only about controlling inflammation. The goal is also to improve quality of life and help people participate fully in work, family life and everyday activities.¹˒²

The recommendations recognise that axSpA affects people in different ways. While inflammation of the spine and sacroiliac joints remains a key feature, many people also experience fatigue, pain, stiffness, mental health challenges, and related conditions such as uveitis, psoriasis and inflammatory bowel disease. As a result, healthcare professionals are encouraged to take a holistic approach that considers the whole person, not just inflammatory symptoms.¹˒²

One of the most significant developments is the expansion of available treatments. While non-steroidal anti-inflammatory drugs (NSAIDs) remain an important first-line option, several biologic and targeted therapies are recommended for people with persistent disease activity. The guidelines support a personalised approach to care, often described as delivering the right treatment to the right person at the right time. They also recognise that if one treatment is not effective or causes unacceptable side effects, switching to another option should be considered.¹˒²

The recommendations place strong emphasis on shared decision-making. Treatment choices should be made jointly by patients and healthcare professionals, taking into account individual goals, preferences, lifestyle factors, and the potential benefits and risks of different therapies.¹˒²

Importantly, the guidelines acknowledge that medication alone is often not enough. Exercise, physiotherapy, education, self-management, pain management and emotional support all play an important role in living well with axSpA. This broader view of care aligns with themes discussed at EULAR 2026, including patient-centred outcomes, quality of life, and equitable access to care, alongside disease control.³

Why Do These Guidelines Matter for Patient Organisations?

Although treatment guidelines are written primarily for healthcare professionals, they are also valuable tools for patient organisations.

They provide an evidence-based framework for advocacy, helping organisations make the case for earlier diagnosis, improved access to rheumatology services, multidisciplinary care, and wider availability of effective treatments.¹˒²

This is especially important because axSpA symptoms often begin in early adulthood, yet diagnosis can take several years. Many people still face delays in diagnosis, limited access to specialists, or restrictions on advanced therapies. By comparing local practice with international recommendations, patient organisations can identify gaps and advocate for meaningful improvements.²

The guidelines can also support patient education, helping people understand their treatment options and encouraging them to take an active role in decisions about their care.

Ultimately, these recommendations reinforce a message that patient organisations have championed for years: successful treatment is about more than controlling inflammation. Together, they point towards a future of more personalised care, greater treatment choice, and a stronger focus on the outcomes that matter most to people living with axSpA.

References

Ramiro S, Nikiphorou E, Sepriano A, et al. (2023). ASAS-EULAR Recommendations for the Management of Axial Spondyloarthritis: 2022 Update. Annals of the Rheumatic Diseases, 82(1), 19-34. [ard.bmj.com], [pubmed.ncb…lm.nih.gov]

Zhao SS, Harrison SR, Thompson B, et al. (2025). The 2025 British Society for Rheumatology guideline for the treatment of axial spondyloarthritis with biologic and targeted synthetic DMARDs. Rheumatology, 64(6), 3242-3254. [academic.oup.com], [research-p….uea.ac.uk]

Axial Spondyloarthritis International Federation (2026). EULAR 2026 Report. [asif.info]

Note: Treatment guidelines support healthcare professionals in making evidence-based decisions. People with axSpA should discuss treatment options with their healthcare team.