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