What role do biologic therapies play in the management of spondyloarthritis, and when should they be considered?

Biologic therapies play a role in the management of spondyloarthritis, particularly for cases that do not respond adequately to NSAIDs or standard DMARDs. In axial spondyloarthritis, biologics such as TNF-alpha inhibitors (e.g., adalimumab, etanercept, infliximab, golimumab) are recommended if the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score remains 4 units or more and NSAIDs are insufficient or not tolerated. For non-radiographic axial spondyloarthritis with objective signs of inflammation, biologics like golimumab, adalimumab, certolizumab pegol, and etanercept are options if NSAIDs are ineffective or not tolerated. Biologics are also considered when standard treatments fail to control the disease activity, with specific guidance on their use after trials of NSAIDs and DMARDs. Regular review is necessary to assess treatment response, and biologics should only be continued if there is clear evidence of benefit.