Spondyloarthritis
Also known as: ankylosing spondylitis · axial spondyloarthritis · PsA · psoriatic arthritis
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ACR/SAA/SPARTAN Axial Spondyloarthritis Guideline (2026 update)
American College of Rheumatology (ACR) / Spondylitis Association of America (SAA) / Spondyloarthritis Research and Treatment Network (SPARTAN) · 2026 · 2026 update
The ACR's axial spondyloarthritis guideline page, which hosts the 2026 update of the joint ACR/SAA/SPARTAN recommendations for adults together with a newly developed companion document for children and adolescents. The page also archives the previous 2019 update, which covered pharmacologic and non-pharmacologic treatment, comorbidities, disease-activity assessment and imaging.
- The ACR guideline page lists a 2026 axial spondyloarthritis guideline as the most recent version, posted in June 2026. source
- The preceding version was the 2019 ACR/SAA/SPARTAN update for ankylosing spondylitis and non-radiographic axial spondyloarthritis. source
- The 2026 release is accompanied by a first dedicated guideline for juvenile axial spondyloarthritis. source
ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update
Assessment of SpondyloArthritis international Society (ASAS) and EULAR · 2023 · 2022 update
Joint ASAS and EULAR recommendations on managing axial spondyloarthritis, published in Annals of the Rheumatic Diseases. The document sets out overarching principles plus recommendations spanning treatment targets and monitoring, non-pharmacological care, NSAIDs as initial drug therapy, and criteria for moving to biologic or targeted synthetic DMARDs.
- Comprises five overarching principles and 15 recommendations with an emphasis on individualised treatment choices. source
- NSAIDs are positioned as the first-choice pharmacological option before escalation to biologic or targeted synthetic DMARDs. source
- Drug selection takes account of extra-musculoskeletal manifestations such as uveitis, inflammatory bowel disease and psoriasis. source
US vs EU key differences
- The two now converge on biologic sequencing: both treat TNF inhibitors and IL-17 inhibitors as equally acceptable first advanced therapies, with monoclonal TNF inhibitors favoured for uveitis or inflammatory bowel disease and IL-17 inhibitors for significant psoriasis. source
- The European document sets a hard numeric gate for starting advanced therapy - ASDAS of at least 2.1 after failure of at least two NSAIDs, plus elevated CRP, MRI sacroiliac inflammation or radiographic sacroiliitis - while the ACR pathway is framed around inadequate NSAID response without an equivalent composite-score cut-off. source
- The ACR guideline explicitly places JAK inhibitors behind TNF and IL-17 inhibitors rather than as a first-line b/tsDMARD choice. source
- Scope and currency differ: the ACR/SAA/SPARTAN release refreshes the 2019 adult guidance and adds a first dedicated guideline for children and adolescents, whereas the ASAS-EULAR document dates to 2022 and covers adults only. source
What changed recently
- US2019 guideline → 2026 update2026-06-24
The 2026 revision of the 2019 adult guideline adds JAK inhibitors as a recommended option (a class absent from the previous version), keeps TNF and IL-17 inhibitors as the preferred first biologics, and advises against IL-23 inhibitors. It also broadens scope with new guidance on nociplastic pain, imaging strategy, bone health and comorbidities, and is accompanied by a first-ever companion guideline for juvenile axial spondyloarthritis.
- EU2016 update → 2022 update2022-10-21
Of the 15 recommendations, eight were carried over unchanged and three had wording changes, while the biologic/targeted-synthetic DMARD indication was revised to require an ASDAS of at least 2.1 after failure of two NSAIDs. Two entirely new recommendations were added: one on choosing drugs according to extra-musculoskeletal manifestations such as uveitis, inflammatory bowel disease and psoriasis, and one on re-checking the diagnosis and comorbidities when treatment fails.
source ↗curation confidence 90%
See the full update feed for changes across every system.