← Questions/TREATMENT
Which treatment comes first, and what comes after?
The short answer
Current guidelines start with anti-inflammatory tablets and exercise, and move to an injected biologic, either a TNF blocker or an IL-17 blocker, or to an oral JAK inhibitor, when disease stays active. All three drug classes control symptoms; the evidence for slowing spinal damage is longest for TNF blockers and still accumulating for the others. The Korean 2026 guideline and the SPARTAN 2026 review give the clearest current picture of that sequence, including switching and tapering.
4 papers behind this answer, best first
Clicking through to a study? How to read a paper is the ten-minute version.
Korean College of Rheumatology treatment recommendations for patients with axial spondyloarthritis: 2026 update.
Journal of rheumatic diseases
Korea's 2026 rheumatology guideline sets out 20 recommendations for axial spondyloarthritis: treat to a target, measure disease with ASDAS, stop smoking and exercise, start with anti-inflammatories, and move to a TNF, IL-17 or JAK drug when those fail, with guidance on switching, tapering and safety checks. It is a clear, current picture of what standard care looks like in 2026.
Therapeutics in Axial Spondyloarthritis: A Review of What Works - SPARTAN 2026 Annual Meeting Proceedings.
Current rheumatology reports
A 2026 expert review concludes that TNF, IL-17 and JAK drugs all control symptoms in axial spondyloarthritis, that evidence for slowing spinal damage is strongest for TNF blockers and not yet established for JAK inhibitors, and that structured exercise, in sessions of an hour or less, measurably improves activity, function, pain and fatigue. Obesity predicts worse disease and a weaker response to TNF drugs.
Recent advances in biologic therapies for ankylosing spondylitis: a 2024 update
Allergologia et Immunopathologia
Comprehensive bDMARD review covering TNF, IL-17, and JAK inhibitor classes with their efficacy and safety profiles across the AS treatment landscape. Confirms a meaningful patient subset still has inadequate response across all three drug classes.
Advances in Axial Spondyloarthritis Treatment: The Role of Janus Kinase Inhibitors
International Journal of Rheumatic Diseases
Reviews the JAK inhibitor class, tofacitinib, upadacitinib, filgotinib, for axial spondyloarthritis. The 2025 CRA/SPARCC guidelines still place TNF inhibitors first-line, with JAK inhibitors recommended when TNFi is contraindicated or for patients with comorbid IBD.
Plain-language guides on this from patient organisations
Reviewed sources written for patients. They cover the “what do I do” part that research papers can’t.
- SAA: BASDAI disease-activity calculator ↗
Spondylitis Association of America; a score to take to your rheumatologist
- NASS: Guide to advanced therapies, anti-TNF, IL-17 and JAK (PDF) ↗
National Axial Spondyloarthritis Society (UK)
- NHS: Treatment for AS ↗
NHS (UK)
- NASS: Medication for axial SpA ↗
National Axial Spondyloarthritis Society (UK)