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Rapid advances in diagnosis, monitoring, and especially treatment over the past decade have increased the complexity of axSpA management and contributed to variability in clinical practice. To address this need, the Spanish Society of Rheumatology (SER) has developed an updated version of ESPOGU\u00cdA, its clinical practice guideline for spondyloarthritis. This review summarizes the updated recommendations. A multidisciplinary panel (including rheumatologists, other medical specialists, nurses, physiotherapists, methodologists, and patients) formulated key clinical questions using the PICO framework. Systematic literature reviews covering the period 2018\u20132023 were conducted across major databases. Evidence quality and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. When evidence was insufficient, recommendations were formulated through a structured deliberative consensus process using the GRADE Evidence-to-Decision framework. Patient representatives actively contributed throughout the process, and the draft guideline underwent public consultation. ESPOGU\u00cdA provides evidence-based recommendations for the management of adult patients with axSpA, focusing on pharmacological and non-pharmacological interventions. The guideline addresses the use of biologic and targeted synthetic disease-modifying antirheumatic drugs, prognostic factors for treatment response and radiographic progression, management of treatment failure, and strategies for treatment optimization, including dose tapering. Special attention is given to extra-musculoskeletal manifestations such as uveitis, inflammatory bowel disease, and psoriasis. Non-pharmacological approaches\u2014including physical activity, smoking cessation, weight management, and nurse-led education\u2014are emphasized as integral components of comprehensive care. ESPOGU\u00cdA 2024 offers a comprehensive, evidence-based framework to support harmonized and patient-centered management of axSpA in Spain. By integrating recent therapeutic advances and multidisciplinary perspectives, the guideline aims to reduce variability in clinical practice, improve outcomes, and enhance quality of life for patients with axSpA, while also identifying key areas for future research.<\/jats:p>","DOI":"10.1177\/1759720x261464260","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T11:10:00Z","timestamp":1785582600000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Therapeutic management of axial spondyloarthritis: summary of 2024 update of the Spanish clinical practice guideline (ESPOGUIA)"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2309-5837","authenticated-orcid":false,"given":"Clementina","family":"L\u00f3pez-Medina","sequence":"first","affiliation":[{"name":"Hospital Reina Sof\u00eda, IMIBIC, University of C\u00f3rdoba, C\u00f3rdoba 14004, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2258-2868","authenticated-orcid":false,"given":"Carlos","family":"Montilla-Morales","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of the University of Salamanca, Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireia","family":"Moreno","sequence":"additional","affiliation":[{"name":"Parc Taul\u00ed Research and Innovation Institute (I3PT), Hospital Parc Taul\u00ed and Universidad Aut\u00f3noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel Jose","family":"Moreno-Ramos","sequence":"additional","affiliation":[{"name":"Hospital Virgen de la Arrixaca, Biomedical Research Institute of Murcia Pascual Parrilla\u2013IMIB, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8418-7145","authenticated-orcid":false,"given":"Rub\u00e9n","family":"Queiro","sequence":"additional","affiliation":[{"name":"Rheumatology and ISPA Translational Immunology Division, Central University Hospital of Asturias, Oviedo University School of Medicine, Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7047-8056","authenticated-orcid":false,"given":"Julio","family":"Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic and IDIBAPS, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"D\u00edaz-Valle","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednico San Carlos, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agn\u00e8s","family":"Fern\u00e1ndez-Clotet","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josep","family":"Riera","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"D\u00edaz-del Campo","sequence":"additional","affiliation":[{"name":"Spanish Society of Rheumatology (SER), Salamanca, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan D.","family":"Ca\u00f1ete","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Hospital Clinic and IDIBAPS, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4527-852X","authenticated-orcid":false,"given":"Victoria","family":"Navarro-Comp\u00e1n","sequence":"additional","affiliation":[{"name":"Hospital Universitario La Paz, IdiPaz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)02263-3"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2020-001450"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223296"},{"key":"e_1_3_4_5_2","volume-title":"Actualizaci\u00f3n","author":"Sociedad Espa\u00f1ola de Reumatolog\u00eda","year":"2024","unstructured":"Sociedad Espa\u00f1ola de Reumatolog\u00eda. 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