Axial spondyloarthritis (
axSpA) is a chronic inflammatory disease predominantly affecting the axial skeleton (sacroiliac joints and spine). Nonradiographic
axSpA (
axSpA without radiographic
sacroiliitis) and
ankylosing spondylitis (AS; radiographic form of
axSpA) are considered nowadays as two consecutive stages of one disease. Nonsteroidal anti-inflammatory drugs (
NSAIDs) are highly effective against the major symptoms of
axSpA (
pain and stiffness) and may have disease-modifying properties including retarding progression of structural damage in the spine. Therefore,
NSAIDs, unless contraindicated, are the treatment of choice for the majority of patients with
axSpA. Beyond
NSAIDs, only tumour
necrosis factor (TNF) α blockers are effective and approved for the treatment of active
axSpA. Several novel drugs (i.e.
monoclonal antibodies targeting
interleukin-17,
interleukin-12/23, inhibitors of
phosphodiesterase-4 and
kinases), which might be effective in
axSpA, are currently under investigation. Pharmacological
therapy of
axSpA should always be combined with nonpharmacological treatment including education and regular exercise/physiotherapy.