{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:31:37Z","timestamp":1792812697564,"version":"4.5.0"},"reference-count":52,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T00:00:00Z","timestamp":1566432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100012495","name":"Spondylitis Association of America","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012495","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["ZIA\u2010AR\u2010041153"],"award-info":[{"award-number":["ZIA\u2010AR\u2010041153"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      To update evidence\u2010based recommendations for the treatment of patients with ankylosing spondylitis (\n                      <jats:styled-content style=\"fixed-case\">AS<\/jats:styled-content>\n                      ) and nonradiographic axial spondyloarthritis (SpA).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted updated systematic literature reviews for 20 clinical questions on pharmacologic treatment addressed in the 2015 guidelines, and for 26 new questions on pharmacologic treatment, treat\u2010to\u2010target strategy, and use of imaging. New questions addressed the use of secukinumab, ixekizumab, tofacitinib, tumor necrosis factor inhibitor (\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      i) biosimilars, and biologic tapering\/discontinuation, among others. We used the Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations and required at least 70% agreement among the voting panel.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Recommendations for\n                      <jats:styled-content style=\"fixed-case\">AS<\/jats:styled-content>\n                      and nonradiographic axial SpA are similar.\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      i are recommended over secukinumab or ixekizumab as the first biologic to be used. Secukinumab or ixekizumab is recommended over the use of a second\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      i in patients with primary nonresponse to the first\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      i.\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      i, secukinumab, and ixekizumab are favored over tofacitinib. Co\u2010administration of low\u2010dose methotrexate with\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      i is not recommended, nor is a strict treat\u2010to\u2010target strategy or discontinuation or tapering of biologics in patients with stable disease. Sulfasalazine is recommended only for persistent peripheral arthritis when\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      i are contraindicated. For patients with unclear disease activity, spine or pelvis magnetic resonance imaging could aid assessment. Routine monitoring of radiographic changes with serial spine radiographs is not recommended.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      These recommendations provide updated guidance regarding use of new medications and imaging of the axial skeleton in the management of\n                      <jats:styled-content style=\"fixed-case\">AS<\/jats:styled-content>\n                      and nonradiographic axial SpA.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/art.41042","type":"journal-article","created":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T05:01:15Z","timestamp":1566450075000},"page":"1599-1613","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":557,"title":["2019 Update of the American College of Rheumatology\/Spondylitis 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