ASAS/EULAR ecommendations for the management of ankylosing spondylitis

University of Toronto, Toronto, Ontario, Canada
Annals of the Rheumatic Diseases (Impact Factor: 10.38). 05/2006; 65(4):442-52. DOI: 10.1136/ard.2005.041137
Source: PubMed


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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Available from: Rubén Burgos-Vargas
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    • "In 2000, Uhrin et al. also showed that even unsupervised recreational exercise improves pain and stiffness [11]. ASAS/EULAR also suggested that optimal management requires a combination of nonpharmacological and pharmacological treatments, and home exercise was listed in category IIa in evidence of efficacy [12]. Because most patients with AS in our country are employed, inpatient or regular outpatient exercise program may be not feasible for many patients with AS. "
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    ABSTRACT: Home exercise is often recommended for management of patients with ankylosing spondylitis (AS); however, what kind of home exercise is more beneficial for patients with AS has not been determined yet. We aimed to compare the effectiveness of combined home exercise (COMB) and range-of-motion home exercise (ROM) in patients with AS. Nineteen subjects with AS completed either COMB (n = 9) or ROM (n = 10) program. The COMB program included range-of-motion, strengthening, and aerobic exercise while the ROM program consisted of daily range-of-motion exercise only. After exercise instruction, subjects in each group performed home exercise for 3 months. Assessment included cardiopulmonary exercise test, pulmonary function test, spinal mobility measurement, chest expansion, Bath Ankylosing Spondylitis Functional Index (BASFI), and other functional ability and laboratory tests. After exercise, the COMB group showed significant improvement in peak oxygen uptake (12.3%, P = 0.008) and BASFI (P = 0.028), and the changed score between pre- and postexercise data was significantly greater in the COMB group regarding peak oxygen uptake and BASFI. Significant improvement in finger-to-floor distance after 3-month exercise was found only in the COMB group (P = 0.033). This study demonstrates that a combined home exercise is more effective than range-of-motion home exercise alone in aerobic capacity and functional ability.
    Full-text · Article · Sep 2014 · BioMed Research International
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    • "Although the term “rheumatoid spondylitis” is used to describe the cervical involvement of RA, it can also be used for people who have both diseases concomitantly. Different disease-modifying antirheumatic drugs (DMARDs) are used for the treatment of these diseases [3]. The efficacy and safety of rituximab (RTX), in addition to DMARDs and anti-TNF-alpha drugs, have been proved in the treatment of RA. "
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    ABSTRACT: Rheumatoid arthritis (RA) is considered as a connective tissue disease while ankylosing spondylitis (AS) is a prototype of spondyloarthritis. These diseases are seen concomitantly only very rarely. Also, rituximab has proven efficacy in the treatment of RA while its role in the treatment of AS is unclear. In this presentation, the concomitant presence of RA and AS in a 43-year-old male patient as well as the efficacy and safety of rituximab is discussed. Rituximab was given due to lack of response to treatment with anti-TNF-alpha. Evaluations made at the 6th and 12th months of treatment showed complete response for RA and partial response for AS.
    Full-text · Article · Nov 2013
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    • "The disease affects mostly young individuals in the third and fourth decade of their life and may therefore have a major impact on their work ability, which is associated with increased costs to the patient and the healthcare system [3]. Disease modifying antirheumatic drugs (DMARDs), including methotrexate and sulfasalazine, have not shown efficacy in treating the axial manifestations of AS but may be beneficial in treating peripheral joint disease [4]. NSAIDs along with patient educational programs, regular physiotherapy , and exercises have been recommended as the standard therapy for axial AS. "
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    ABSTRACT: The rationale of the study was to evaluate the efficacy of infliximab (IFX) treatment in patients with ankylosing spondylitis (AS) and to determine whether IFX dose reduction and interval extension sustains the treatment effect. Nineteen patients were included and treated with IFX 5 mg/kg every 6 weeks for 56 weeks. All patients concomitantly received MTX with median dose 7.5 mg/weekly. During the second year, the IFX dose was reduced to 3 mg/kg every 8 weeks. Eighteen patients completed the 1-year and 15 patients the 2-year trial. The ≥50% improvement at week 16 from baseline of BASDAI was achieved in 16/19 (84%) patients. Significant reductions in BASDAI, BASFI, and BASMI scores, decrease in ESR and CRP, and improvement in SF-36 were observed at weeks 16 and 56. The MRI-defined inflammatory changes in the sacroiliac joints disappeared in 10/15 patients (67%) already at 16 weeks. IFX treatment effect was sustained throughout the second year after IFX dose reduction and interval extension. We conclude that IFX treatment is effective in well-established active AS and a dose reduction sustains the treatment effect. These observations are of clinical importance and open the opportunity to reduce the drug costs. This trial is registered with NCT01850121.
    Full-text · Article · Sep 2013 · Mediators of Inflammation
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