What do you try in patients with IBD-related spondyloarthritis with predominantly axial symptoms who are refractory to TNF inhibitors?  

Treating these patients is challenging. It's always good to circle back to first-line therapy recommendations for axial spondyloarthritis and ensure that patients are doing physical therapy or exercise daily. Patients whose IBD is in remission may be able to add a COX-2 selective NSAID (celecoxib), ...