Updated guidelines for axial spondyloarthritis

Article kindly produced by Eden Ward, Journal Development Officer, British Society for Rheumatology.

The British Society for Rheumatology have recently published an updated evidence-based clinical guideline for the treatment of axial spondyloarthritis (axSpA) with biologic and targeted synthetic DMARDs.

What do the new guidelines cover?

Almost 10 years since the previous iteration, the updated guideline provides a practical working framework for the contemporary management of axSpA with new therapies and non-pharmacological treatment options.

While the diagnosis and management of axSpA largely occurs in specialist care, primary care may be involved in managing flares of disease. The guideline will aid GPs to identify early symptoms, leading to referrals to specialist care earlier and improving diagnostic times.

Discussing how the guideline will support colleagues in primary care, Will Gregory, Consultant Physiotherapist and GWG member, said:

“It relates to the first overarching principle we published, which is that our primary goal of treatment for people living with axSpA is to enable them to lead healthy and productive lives, and that therefore gives us a remit for the guideline to cover every version of axSpA. We cover advanced therapies for those people living with a more severe or advanced version of the condition, but we're seeing a big population of our axSpA cohort who perhaps don't reach that requirement, and therefore they may be more managed in primary care. So, I think the guideline, with its scope, will increase the knowledge of our primary care colleagues, particularly as they're seeing more MSK work in extended roles.”

See below for some key recommendations:

• Management decisions should be developed in partnership with the individual living with axSpA based on their needs and priorities, within the available resources.
• Management should involve a multidisciplinary team (MDT) coordinated by a rheumatologist, utilizing a holistic approach that incorporates both pharmacological and non-pharmacological interventions.
• Physical activity, supervised exercise and physiotherapy are foundational for axSpA management. Supervised therapies have a stronger evidence base, but all forms of regular physical activity are likely to provide axSpA specific as well as general health benefits.
• Psychological therapies are important to address the high burden of mental health comorbidity among people with axSpA and can range from remotely delivered cognitive-behavioural therapy to clinical psychology as part of the MDT.
• Supported self-management: people with axSpA should be empowered to manage their condition through need-based education, including being directed to appropriate resources for additional information and support.

The guideline was developed by a multiprofessional guideline working group (GWG) of 21 members from across the UK, as well as experts by experience and patient organisation representatives. The GWG also included non-rheumatology experts covering ophthalmology, gastroenterology, and primary care.

We are delighted that the guideline is endorsed by:

• The National Axial Spondyloarthritis Society (NASS)
• The British Society of Gastroenterology
• The Royal College of Ophthalmologists
• The Primary Care Rheumatology and Musculoskeletal Medicine Society.

The inclusion of experts by experience within the guideline working group is invaluable. Their input ensures the guideline considers all aspects of patient care journeys.

Dale Webb, expert by experience GWG member and Chief Executive Officer of the National Axial Spondyloarthritis Society, reflects on how the guideline will benefit patients:

“I think this will be good news for patients. It will be reassuring to know that a group has been meeting behind the scenes to consider the latest evidence and that therefore the treatment decisions that the clinician is making with patients is based upon the best available evidence, and that patients are a key part of that decision making process.”

The guideline, alongside a handy summary sheet, is now available to read in Rheumatology.

An audit tool has also been developed to assist the implementation of the guideline

Find out more:

• Access all the BSR guidelines via the BSR guidelines homepage.
• You can now listen to episodes of the BSR Talking Rheumatology podcast to hear interviews with the guidelines’ authors and their key take-home messages.
• These Rheumatology Roundtable: Axial spondyloarthritis guideline (2025) interviews are also available in video format on the BSR YouTube channel.