Patient handout

Axial spondyloarthritis

PRODUCTION

1. Your condition

This handout is for axial spondyloarthritis. Your care team identified this based on: chronic inflammatory back pain (insidious onset <45 y, >3 months) (asas-eular 2022; asas ibp criteria sieper 2009).

Other reasons your team may use this plan: enthesitis (achilles/plantar fascia), dactylitis, or asymmetric lower-limb oligoarthritis (asas-eular 2022); acute anterior uveitis, psoriasis, or ibd with chronic back pain (asas-eular 2022; acr/saa/spartan 2019); hla-b27 positive with chronic back pain or family history of spa (asas classification criteria rudwaleit 2009).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
structured exercise & physiotherapy	—	n/a	lifelong, regular	ASAS-EULAR 2022 — patient education + regular exercise (home + supervised land/water physiotherapy) is the lifelong cornerstone; preserves mobility and function alongside any pharmacotherapy
naproxen	500 mg	PO	BID	ASAS-EULAR 2022 — NSAID first-line; continuous max-tolerated dosing preferred over on-demand when disease active; assess GI/CV/renal risk and add gastroprotection as needed
celecoxib	200 mg	PO	once daily–BID	ASAS-EULAR 2022 — COX-2 selective alternative when GI risk; ≥2 different NSAIDs over ≥4 weeks each before declaring NSAID failure

Plan: axSpA treat-to-target ladder (exercise + NSAID cornerstone → bDMARD by EMM → JAKi → switch)

3. When to call your provider

Contact your care team if any of the following happen:

New severe eye pain/photophobia/redness → urgent same-day ophthalmology for acute anterior uveitis (ASAS-EULAR 2022)
Low-energy back pain in known AS / bamboo spine → CT spine + immobilise, ED referral for occult fracture (ASAS-EULAR 2022)
New neurologic deficit / saddle anaesthesia / bladder dysfunction → ED for cauda equina / cord injury (ACR/SAA/SPARTAN 2019)
New dyspnoea, syncope, diastolic murmur → cardiology for aortitis/aortic regurgitation/AV block (ASAS-EULAR 2022)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Low-energy spinal trauma in known AS / bamboo (ankylosed) spine — high risk of unstable fracture and spinal-cord injury (ASAS-EULAR 2022; ACR/SAA/SPARTAN 2019)(life-threatening)
Saddle anaesthesia, bladder/bowel dysfunction, or progressive lower-limb weakness in axSpA (cauda equina or cord compromise) (ACR/SAA/SPARTAN 2019)(life-threatening)
Acute unilateral painful red eye with photophobia/visual change in axSpA (acute anterior uveitis) (ASAS-EULAR 2022)
New aortic regurgitation, ascending aortitis, or high-grade/complete AV block in axSpA (ASAS-EULAR 2022)
Planned bDMARD/JAKi with positive IGRA/TST or HBsAg/anti-HBc without prophylaxis (ASAS-EULAR 2022)

5. Follow-up

Lifelong rheumatology follow-up; ongoing exercise/physiotherapy; consider tapering (not abrupt stop) of bDMARD in sustained remission; smoking cessation (accelerates radiographic progression); spine/posture and fall-prevention counselling; uveitis return precautions; vaccination + cardiovascular + bone-health maintenance; hip arthroplasty/spinal osteotomy referral for advanced structural disease (ASAS-EULAR 2022; ACR/SAA/SPARTAN 2019)

6. Sources

Guideline: 2022/2023 ASAS-EULAR axSpA management recommendations + 2019 ACR/SAA/SPARTAN AS/nr-axSpA guideline + ASAS classification criteria