Clinical Dialogue: Back in Business: Strategies for the Diagnosis and Management of Patients with Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton and to a lesser extent the peripheral skeleton. It is characterized by lower back pain from chronic inflammation that may progress to structural damage in the sacroiliac joints and spine. AS is now classified as part of the broader disorder of axial spondyloarthritis, an umbrella term that includes both AS and non-radiographic axial spondyloarthritis (nr-axSpA). AS encompasses patients with visible structural damage as seen on radiographs, whereas nr-axSpA encompasses patients without this visible structural damage. In the U.S., AS affects approximately 0.5% of the population, which equates to 1.5 million people. To provide quality care for patients with AS, PAs and other healthcare providers must remain up to date on all aspects of disease management. In 2019, the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network (ACR/SAA/SPARTAN) updated their guidelines, highlighting the need for continuing education on AS management.

Learning Objectives
At the conclusion of this activity, the PA should be better able to:
  • Use knowledge of clinical characteristics of AS and differential diagnosis from mechanical back pain when evaluating patients.
  • Utilize appropriate imaging for the diagnosis of AS.
  • Outline therapies available to treat AS, including recommendations for therapy escalation based on established guidelines.
  • Manage patients with stable disease appropriately.
  • Apply knowledge of common comorbidities, particularly cardiovascular disease when managing patients with AS.