Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.
Reference tool — not medical advice. Deterministic treat-to-target suggestions to think with, grounded in current axSpA guidelines. The model drafts options; a clinician decides. Runs entirely in your browser — no data is collected.

Evidence: Hamilton L, Barkham N, Bhalla A 2025 · sources last checked 2026-08-20

axSpA / ankylosing spondylitis treatment selector

Pick the disease activity, prior NSAID trials, phenotype, and any extra-musculoskeletal manifestations to get ranked treat-to-target suggestions — NSAIDs + exercise first, then the Health Canada-approved TNF, IL-17, and JAK inhibitors — with the guideline reasoning, EMM steering, and safety gates behind each.

Guideline lens

Patient profile

Disease activity

Prior NSAID trials

Phenotype

Extra-musculoskeletal manifestations

Biologic status

Cautions & contraindications

TNFi are routed out for demyelinating disease and NYHA III/IV heart failure; JAKi and methotrexate are routed out in pregnancy.

Select a patient profile to begin.

e.g. active disease + failed ≥2 NSAIDs + recurrent uveitis, or TNFi failure + psoriasis to see how the EMM steering and safety gates shift the ranking.

References

  1. [1]Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023;82(1):19–34. doi:10.1136/ard-2022-223296. link
  2. [2]Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the ACR/SAA/SPARTAN Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol 2019;71(10):1599–1613 (and Arthritis Care Res 2019;71(10):1285–1299). link
  3. [3]Hamilton L, Barkham N, Bhalla A, et al. The 2025 British Society for Rheumatology guideline for the treatment of axial spondyloarthritis with biologic and targeted synthetic DMARDs. Rheumatology (Oxford) 2025;64(6):3242–3259. doi:10.1093/rheumatology/keaf090. link
  4. [4]Health Canada — Drug Product Database & product monographs (Humira, Enbrel, Remicade, Simponi, Cimzia, Cosentyx, Taltz, Bimzelx, Rinvoq, Xeljanz; and biosimilars). Bimzelx axSpA approval Mar 2024; Rinvoq AS 2022 / nr-axSpA 2023; Xeljanz AS 2023. link
  5. [5]Uveitis in axSpA — monoclonal TNF inhibitors reduce anterior-uveitis flares more than etanercept (registry: ~2.9–4.0 vs 7.5 per 100 patient-years); IL-17 inhibitors are inferior to monoclonal TNFi for uveitis. Summarized in BSR 2025 (ref 3). link
  6. [6]IL-17 inhibition and IBD — secukinumab did not improve (and signalled worsening of) Crohn's disease; IL-17 inhibitors should not be started in active IBD. Etanercept was not superior to placebo for Crohn's (ineffective for IBD). Hueber W, et al. Gut 2012;61:1693; BSR 2025 (ref 3). link
  7. [7]Ytterberg SR, et al. ORAL Surveillance: Cardiovascular and cancer risk with tofacitinib in rheumatoid arthritis. NEJM 2022;386:316. FDA/EMA JAK-inhibitor class warnings — caution in age >65, current/past smokers, and CV or malignancy risk (applies to upadacitinib/tofacitinib). link
  8. [8]Biosimilars & coverage — adalimumab/etanercept/infliximab biosimilars are payer-preferred/mandated in Canada (provincial non-medical switching); guidelines treat biosimilars as therapeutically equivalent. Provincial/private special-authority for axSpA biologics requires documented active disease + prior failure of ≥2 NSAIDs (criteria vary by jurisdiction). link