2025 Consensus-based recommendations for the referral, diagnosis, monitoring, and management of axial spondyloarthritis in the Arabian Gulf countries.

BACKGROUND

Standardized recommendations for managing axial spondyloarthritis (axSpA) in the context of the Arabian Gulf region are currently limited.

OBJECTIVE

We aimed to develop evidence-based consensus recommendations for the referral, diagnosis, monitoring, and management of axSpA patients in the Arabian Gulf countries.

METHOD: A task force of seven expert rheumatologists from Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates, along with an advisor, drafted recommendations regarding axSpA patient care based on a systematic literature review (PROSPERO CRD42023403697) of PubMed, Medline, and Cochrane databases. Consensus required a level of agreement ≥70%. Patient research partners and rheumatologists from the region externally validated the statements.

RESULTS

Six overarching principles and 21 recommendations, tailored to the needs of the region, were developed. Key principles discussed timely referral to rheumatologists, the diagnostic utility of HLA-B27, shared decision-making, and multidisciplinary management combining non-pharmacological and pharmacological treatment. Training rheumatologists and radiologists on imaging is recommended. MRI of sacroiliac joints is preferred for diagnosis, with spinal MRI or CT of SIJs as alternatives. Cost-effective treatments, such as biosimilars, and alternative routes of drug administration should be prioritized. Treatment failure should prompt reassessment of diagnosis and evaluation of comorbidities. Regularly monitoring cardiovascular risk, pregnancy planning, disease activity monitoring during pregnancy, and use of electronic patient-reported outcome measures for informed decisions are recommended. Regional and national axSpA registries can facilitate evidence generation and enhance management.

CONCLUSION

These are the first consensus recommendations tailored to the Arabian Gulf setting, integrating current evidence and regional expertise to optimize the care of axSpA patients.