Korean College of Rheumatology treatment recommendations for patients with axial spondyloarthritis: 2026 update

Min, Hong Ki; Seo, Mi Ryoung; Lee, Sang-Hoon; Lee, Yeon-Ah; Lee, Jennifer Jooha; Kwon, Seong-Ryul; Kim, Tae-Hwan; Park, Min-Chan; Shin, Kichul; Ju, Ji Hyeon; Kim, Yong-Gil; Koo, Bon San; Lee, Eun Young; Cha, Hoon-Suk; Shim, Seung Cheol; Shin, Ji Hui; Kim, Tae-Jong; ,

doi:.0..

Korean J Intern Med > Epub ahead of print

GUIDELINE

Korean College of Rheumatology treatment recommendations for patients with axial spondyloarthritis: 2026 update

Hong Ki Min¹, Mi Ryoung Seo², Sang-Hoon Lee³, Yeon-Ah Lee⁴, Jennifer Jooha Lee⁵, Seong-Ryul Kwon⁶, Tae-Hwan Kim⁷, Min-Chan Park⁸, Kichul Shin⁹, Ji Hyeon Ju⁵, Yong-Gil Kim¹⁰, Bon San Koo¹¹, Eun Young Lee¹², Hoon-Suk Cha¹³, Seung Cheol Shim¹⁴, Ji Hui Shin⁷, Tae-Jong Kim¹⁵

, and on behalf of the Korean College of Rheumatology-Alliance of eXperts In Spondyloarthritis (KCR-AXIS)

¹Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
²Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
³Department of Rheumatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
⁴Division of Rheumatology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
⁵Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
⁶Division of Rheumatology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
⁷Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
⁸Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
⁹Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
¹⁰Division of Rheumatology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
¹¹Division of Rheumatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
¹²Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
¹³Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
¹⁴Division of Rheumatology, Daejeon Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, Korea
¹⁵Department of Rheumatology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea

Corresponding Author: Tae-Jong Kim , Tel: +82-62-220-5474, Fax: +82-62-225-8578, Email: ktj1562@jnu.ac.kr

Received: July 7, 2026; Revised: July 22, 2026; Accepted: August 3, 2026.

Abstract

We aimed to develop updated evidence-based recommendations for the management of adult patients with axial spondyloarthritis (axSpA) in Korea. The Korean College of Rheumatology convened a multidisciplinary panel to update the 2023 axSpA guideline. Twenty key clinical questions were formulated using the PICO framework. Systematic literature searches were conducted in PubMed, Embase, and the Cochrane Library for studies published between February 2021 and December 2024. Evidence was appraised using the GRADE methodology, and recommendations were finalized through a modified Delphi consensus process. Twenty recommendations were developed covering disease activity monitoring, non-pharmacological interventions, pharmacological treatment, treatment sequencing, tapering strategies, comorbidity management, surgical interventions, and safety monitoring. Key recommendations include implementation of a treat-to-target strategy, use of Axial Spondyloarthritis Disease Activity Score for disease assessment, smoking cessation and exercise, nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, and the use of tumor necrosis factor inhibitors, interleukin-17 inhibitors, or Janus kinase inhibitors in patients with active disease refractory to NSAIDs. Recommendations were also provided for treatment selection according to extra-musculoskeletal manifestations and for monitoring treatment-related adverse events. These updated recommendations provide evidence-based guidance for the comprehensive management of axSpA in Korea and aim to improve clinical outcomes, quality of life, and standardization of care.

Keywords: Axial spondyloarthritis ; Guideline ; Recommendation ; GRADE