The Future of Axial Spondyloarthritis Treatment

Hillary Norton, MD: There are unmet needs yet in the treatment of axSpA [axial spondyloarthritis] and AS [ankylosing spondylitis] patients. TNF [tumor necrosis factor] inhibitors and IL-17 inhibitors work very well for many of our patients, but we still have cases in which if someone doesn’t respond to 1 of these biologics, the pipeline includes new classes of medications that are coming, and this will provide more options for these patients who don’t respond to the medications we currently have.

I think the main thing to keep in mind for community physicians who are seeing people with back pain is the distinction between mechanical and inflammatory back pain. If somebody comes in under the age of 35 with back pain that has been persistent for more than 3 months, who has night pain, particularly in the second half of the night, and pain that is better with activity and worse with rest, and is responsive to NSAIDs [nonsteroidal anti-inflammatory drugs], these are red flags that this may be treatable inflammatory back pain and a referral to rheumatology is warranted.