A review of the Inflammatory back pain in rheumatology.

What is it about?

Ankylosing Spondylitis (AS) and non-radiographic axial Spondyloarthritis (nr-axSpA), or collectively termed axial Spondyloarthritis (axSpA). These conditions cause significant spinal pain and disability long term and patients most often develop the disease at a relatively young age causing a lifetime of burdensome symptoms. We have described the evidence available in this disease process and further scientific and clinical considerations for both the researcher and treating physician. In particular, we have summarised the medical evidence behind the use of the latest treatments.

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Why is it important?

Patients with AS and nr-axSpA develop significant spinal symptoms and damage that can impair physical function and mobility as well as posture and the full bio-psycho-social status of the patient. The disease has multisystem effects meaning that it can cause problems in other organs of the body. It is because patients often develop the symptoms in their early 30's or even earlier that they have a lifetime burden of symptoms that progressively affects them over time and has profound societal implications. The life long consequences of this disease are profound but we now have effective therapies that are changing the historically poor outcomes that we have been so used to seeing. We describe these treatments which were initially found by chance; namely the anti-TNF (anti -tumour necrosis factor) drugs which were developed to treat Rheumatoid Arthritis initially and then trialled in AS and found to be very effective. Subsequently more anti-TNF drugs have been developed and licensed to treat AS and axSpA and secukinumab, an IL-17A inhibitor has recently been licensed too. These treatments now provide both patient and doctor some choice of therapy to select. But which ones would you select and why? We discuss the specific reasons and rationale to treatments throughout the article.

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