Diagnosis and management of axial spondyloarthritis (axSpA) has vastly improved over the past two decades. With advances in the discernment of immunopathogenesis of this disease, new therapies have become available, which are associated with substantial improvement in symptoms, signs and quality of life. The four broad categories of approved treatment options are physical therapy and exercise (which have been known to be beneficial for millennia), NSAIDs (since the 1950s), TNF inhibitors (first FDA approval in 2003) and IL-17 inhibitors (first FDA approval in 2016). In addition, there have been a host of new developments in the axSpA field, including new treatment guidelines, the FDA approval of three biologic DMARDs to treat non-radiographic axSpA, the FDA and EMA approval of Janus kinase (JAK) inhibitors for ankylosing spondylitis, new data on the effect of biologic DMARDs on structural progression in ankylosing spondylitis, strategy trials on tapering or stopping TNF inhibitors in patients in remission, trials of treat-to-target strategy in axSpA, and several new molecules in phase III studies. This Review explores the developments in the management of axSpA.

在过去的二十年里，中轴型脊柱关节炎 (axSpA) 的诊断和治疗有了很大的改善。随着对这种疾病的免疫发病机制识别的进步，已经出现了新的治疗方法，这些治疗方法与症状、体征和生活质量的显着改善有关。四大类批准的治疗方案是物理治疗和运动（已知对数千年有益）、非甾体抗炎药（自 1950 年代以来）、TNF 抑制剂（2003 年 FDA 首次批准）和 IL-17 抑制剂（FDA 首次批准2016 年）。此外，在 axSpA 领域也有许多新进展，包括新的治疗指南、FDA 批准三种生物 DMARD 治疗非放射学 axSpA、FDA 和 EMA 批准用于强直性脊柱炎的 Janus 激酶 (JAK) 抑制剂, 关于生物 DMARD 对强直性脊柱炎结构进展影响的新数据、缓解患者逐渐减少或停止 TNF 抑制剂的策略试验、axSpA 中的靶向治疗策略试验以及 III 期研究中的几个新分子。本综述探讨了 axSpA 管理的发展。