ASAS/EULAR recommendations for the management of ankylosing spondylitis.

Rheumazentrum-Ruhrgebiet, St Josefs-Krankenhaus, Landgrafenstr 15, 44652 Herne, Germany.
Annals of the Rheumatic Diseases (Impact Factor: 9.11). 05/2006; 65(4):442-52. DOI: 10.1136/ard.2005.041137
Source: PubMed

ABSTRACT To develop evidence based recommendations for the management of ankylosing spondylitis (AS) as a combined effort of the 'ASsessment in AS' international working group and the European League Against Rheumatism.
Each of the 22 participants was asked to contribute up to 15 propositions describing key clinical aspects of AS management. A Delphi process was used to select 10 final propositions. A systematic literature search was then performed to obtain scientific evidence for each proposition. Outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. The effect size, relative risk, number needed to treat, and incremental cost effectiveness ratio were calculated. On the basis of the search results, 10 major recommendations for the management of AS were constructed. The strength of recommendation was assessed based on the strength of the literature evidence, risk-benefit trade-off, and clinical expertise.
The final recommendations considered the use of non-steroidal anti-inflammatory drugs (NSAIDs) (conventional NSAIDs, coxibs, and co-prescription of gastroprotective agents), disease modifying antirheumatic drugs, treatments with biological agents, simple analgesics, local and systemic steroids, non-pharmacological treatment (including education, exercise, and physiotherapy), and surgical interventions. Three general recommendations were also included. Research evidence (categories I-IV) supported 11 interventions in the treatment of AS. Strength of recommendation varied, depending on the category of evidence and expert opinion.
Ten key recommendations for the treatment of AS were developed and assessed using a combination of research based evidence and expert consensus. Regular updating will be carried out to keep abreast of new developments in the management of AS.

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    ABSTRACT: Introduction. Ankylosing spondilitis (AS) is a disease from a group of seronegative spondyloarthropathies with the prevalence of 0.1% affecting mainly young males, which also gives sociomedical significance to the disease. Among all inflammatory arthropathies, AS is the most suitable for balneotherapy. Thermomineral water of the Niška Banja spa is homeothermic, oligomineral, alkaline, low radioactive radon water and also, in conjunction with mineral peloid, is considered to be optimal for this indication. Objective. Our aim was to investigate the effects of natural factors of the Niška Banja spa as a part of complex treatment on the indexes of mobility of the vertebral column in the patients with AS. Methods. The study enrolled 40 patients with the average age of 48.0±14.82 years and the average duration of disease of 16.9±6.42 years. Patients were treated with hydro- and peloid- otherapy during the average of 17.23±2.71 days. At the beginning and at the end of treatment, a number of indexes of spinal mobility were measured. The statistical significance of differences was calculated using the Student&apos;s t-test. Results. All of the measured indexes were better after balneotherapy reaching statistically significant differences in regard to the wall-to-occiput distance (p<0.05), the index of sagittal mobility of the cervical (p<0.05) and lumbar (p<0.005) spine. Conclusion. The application of natural factors of the Niška Banja spa during complex treatment of the patients with AS is accompanied with the objective increase of the spine mobility.
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