How would you manage axial stiffness without pain in an elderly gentleman with a distant history of HLA-B27+ axial and peripheral spondyloarthritis, now with SI joint fusion, no peripheral arthritis, normal inflammatory markers, and no response to TNF inhibition?  

Based on the history and lack of response to anti-TNF therapy, I suspect the patient does not currently have active inflammatory disease but likely sequalae of prior damage and degenerative spinal disease as a cause of his stiffness. A trial off of the biologic would help assess if the medication i...

Further information is needed in order to properly determine what the "stiffness" means: inflammatory vs. non-inflammatory. Certainly in the absence of any clinical response stopping the TNFi agent would be prudent; if there is worsening of symptoms then perhaps it was actually working but not well...