Decoding pain in axial spondyloarthritis: Mechanisms, management, and future directions

Axial spondyloarthritis (axSpA) is an immune-mediated inflammatory condition that is associated with significant disease burden. While the use of biologic and targeted synthetic disease modifying antirheumatic drugs have led to significant improvements in disease outcomes, a substantial proportion of patients continue to face challenges with pain despite effective control of their inflammatory state. Chronic pain is one of the leading causes of disability and remains an unmet research and clinical need in axSpA. Phenotyping pain is essential to understand the etiology of symptoms and to aid in selecting the appropriate management plan in axSpA. In this review, we aim to highlight the mechanisms of pain, its phenotypes, and novel assessment tools. We also review our approach to managing chronic pain in axSpA and discuss future directions in this field.