Pan American League of Associations for Rheumatology recommendations for the management of axial spondyloarthritis

Nat Rev Rheumatol. 2023 Nov;19(11):724-737. doi: 10.1038/s41584-023-01034-z. Epub 2023 Oct 6.


Axial spondyloarthritis (axSpA) comprises a spectrum of chronic inflammatory manifestations affecting the axial skeleton and represents a challenge for diagnosis and treatment. Our objective was to generate a set of evidence-based recommendations for the management of axSpA for physicians, health professionals, rheumatologists and policy decision makers in Pan American League of Associations for Rheumatology (PANLAR) countries. Grading of Recommendations, Assessment, Development and Evaluation-ADOLOPMENT methodology was used to adapt existing recommendations after performing an independent systematic search and synthesis of the literature to update the evidence. A working group consisting of rheumatologists, epidemiologists and patient representatives from countries within the Americas prioritized 13 topics relevant to the context of these countries for the management of axSpA. This Evidence-Based Guideline article reports 13 recommendations addressing therapeutic targets, the use of NSAIDs and glucocorticoids, treatment with DMARDs (including conventional synthetic, biologic and targeted synthetic DMARDs), therapeutic failure, optimization of the use of biologic DMARDs, the use of drugs for extra-musculoskeletal manifestations of axSpA, non-pharmacological interventions and the follow-up of patients with axSpA.

Publication types

  • Practice Guideline

MeSH terms

  • Antirheumatic Agents* / therapeutic use
  • Axial Spondyloarthritis*
  • Biological Products* / therapeutic use
  • Humans
  • Rheumatology*
  • Spondylarthritis* / diagnosis
  • Spondylarthritis* / drug therapy
  • Spondylitis, Ankylosing*


  • Antirheumatic Agents
  • Biological Products