25th February 2025

Management of spondyloarthropathies

First-line therapy involves NSAIDs. These can be contraindicated in IBD and sometimes cause rebound skin symptoms in psoriasis. Alongside this are analgesia adjuncts, physiotherapy and smoking cessation. Corticosteroid injections are recommended for localised inflammation.

If there is poor response of peripheral disease or severe symptoms, second-line treatment may involve the DMARDs sulfasalazine or methotrexate. Leflunomide and ciclosporin are sometimes used in PsA.

With poor response to the above or severe axial symptoms, the biological DMARD TNF-α (tumour necrosis factor) inhibitors can be considered (adalimumab, infliximab, etanercept, golimumab). NICE has also licensed Ustekinumab, an IL-23 inhibitor, in PsA for non-responders.

Management of cardiovascular comorbidities is important.