Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Living Treatment Recommendations for the Management of Axial Spondyloarthritis

Sherry Rohekar; Jordi Pardo Pardo; Reza Mirza; Sibel Z Aydin; Louis Bessette; Nicolas Richard; Dianne Mosher; Tristan Boyd; Jon Chan; Lihi Eder; Laura Passalent; Elie Karam; Bindu Nair; Glen S Hazlewood; Shirley Tse; Dax Rumsey; Michel Zummer; Nigil Haroon; Robert Inman; Dafna D Gladman

doi:10.3899/jrheum.2023-1237

Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Living Treatment Recommendations for the Management of Axial Spondyloarthritis

J Rheumatol. 2025 Jan 1;52(1):10-22. doi: 10.3899/jrheum.2023-1237.

Authors

Sherry Rohekar¹, Jordi Pardo Pardo², Reza Mirza³, Sibel Z Aydin⁴, Louis Bessette⁵, Nicolas Richard⁶, Dianne Mosher⁷, Tristan Boyd⁸, Jon Chan⁹, Lihi Eder¹⁰, Laura Passalent¹¹, Elie Karam¹², Bindu Nair¹³, Glen S Hazlewood¹⁴, Shirley Tse¹⁵, Dax Rumsey¹⁶, Michel Zummer⁶, Nigil Haroon¹⁷, Robert Inman¹⁸, Dafna D Gladman¹⁹

Affiliations

¹ S. Rohekar, MD, Western University, Department of Medicine, Division of Rheumatology, London, Ontario; sherry.rohekar@sjhc.london.on.ca.
² J. Pardo Pardo, LDO, Ottawa Hospital Research Institute, University of Ottawa, and Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario.
³ R. Mirza, MD, MSc, Rheumatologist and Methodologist, McMaster University, Hamilton, Ontario.
⁴ S.Z. Aydin, MD, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario.
⁵ L. Bessette, MD, MSc, Laval University, Department of Medicine, Quebec City, Quebec.
⁶ N. Richard, MD, M. Zummer, MD, Department of Medicine, Université de Montréal, Montreal, and Division of Rheumatology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec.
⁷ D. Mosher, MD, Department of Medicine, University of Calgary, Calgary, Alberta.
⁸ T. Boyd, MD, Department of Medicine, Division of Rheumatology, Western University, Hamilton, Ontario.
⁹ J. Chan, MD, Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia.
¹⁰ L. Eder, MD, PhD, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario.
¹¹ L. Passalent, PT, MHSc, ACPAC, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, and Krembil Research Institute, University Health Network, and Division of Rheumatology, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario.
¹² E. Karam, MD, Department of Family Medicine, University of Ottawa, Ottawa, and Canadian Spondyloarthritis Association, Toronto, Ontario.
¹³ B. Nair, MD, MSc, Division of Rheumatology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan.
¹⁴ G.S. Hazlewood, MD, PhD, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
¹⁵ S. Tse, MD, University of Toronto, and Division of Rheumatology, SickKids, Toronto, Ontario.
¹⁶ D. Rumsey, MD, MSc, University of Alberta, Edmonton, Alberta.
¹⁷ N. Haroon, MD, PhD, DM, University Health Network, Division of Rheumatology, University of Toronto, Schroeder Arthritis Institute, Toronto, Ontario.
¹⁸ R. Inman, MD, Schroeder Arthritis Institute, and University Health Network, and Department of Medicine and Immunology, University of Toronto, Toronto, Ontario.
¹⁹ D.D. Gladman, MD, Department of Medicine, University of Toronto, and Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, and Psoriatic Disease Program, University Health Network, Toronto, Ontario, Canada.

PMID: 38950949
DOI: 10.3899/jrheum.2023-1237

Abstract

Objective: To provide a set of living treatment recommendations that will give contemporary guidance on the management of patients with axial spondyloarthritis (axSpA) in Canada.

Methods: The Spondyloarthritis Research Consortium of Canada (SPARCC), in conjunction with the Canadian Rheumatology Association, organized a treatment recommendations panel composed of rheumatologists, researchers, allied health professionals, and a patient advocate. A Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach was used, in which existing guidelines were adopted or adapted to a Canadian context. Recommendations were also placed in a health equity framework.

Results: Fifty-six recommendations were made for patients with active axSpA, stable axSpA, active or stable axSpA, for comorbidities, and for assessment, screening, and imaging. Recommendations were also made for principles of management, disease monitoring, and ethical considerations.

Conclusion: These living treatment recommendations will provide up-to-date guidance for the management of axSpA for Canadian practice. As part of the living model, they will be updated regularly as changes occur in the treatment landscape.

Keywords: ankylosing spondylitis; evidence-based medicine; practice guidelines; spondyloarthropathy.

Publication types

Practice Guideline

MeSH terms

Antirheumatic Agents / therapeutic use
Axial Spondyloarthritis* / therapy
Canada
Disease Management
Humans
Rheumatology* / standards
Societies, Medical

Substances

Antirheumatic Agents