1
|
van der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A, Regel A, Ciurea A, Dagfinrud H, Dougados M, van Gaalen F, Géher P, van der Horst-Bruinsma I, Inman RD, Jongkees M, Kiltz U, Kvien TK, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compàn V, Ozgocmen S, Pimentel-Santos FM, Reveille J, Rudwaleit M, Sieper J, Sampaio-Barros P, Wiek D, Braun J. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017; 76:978-991. [PMID: 28087505 DOI: 10.1136/annrheumdis-2016-210770] [Citation(s) in RCA: 958] [Impact Index Per Article: 136.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 11/29/2016] [Accepted: 12/05/2016] [Indexed: 12/16/2022]
Abstract
To update and integrate the recommendations for ankylosing spondylitis and the recommendations for the use of tumour necrosis factor inhibitors (TNFi) in axial spondyloarthritis (axSpA) into one set applicable to the full spectrum of patients with axSpA. Following the latest version of the European League Against Rheumatism (EULAR) Standardised Operating Procedures, two systematic literature reviews first collected the evidence regarding all treatment options (pharmacological and non-pharmacological) that were published since 2009. After a discussion of the results in the steering group and presentation to the task force, overarching principles and recommendations were formulated, and consensus was obtained by informal voting. A total of 5 overarching principles and 13 recommendations were agreed on. The first three recommendations deal with personalised medicine including treatment target and monitoring. Recommendation 4 covers non-pharmacological management. Recommendation 5 describes the central role of non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice drug treatment. Recommendations 6-8 define the rather modest role of analgesics, and disprove glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for axSpA patents with predominant axial involvement. Recommendation 9 refers to biological DMARDs (bDMARDs) including TNFi and IL-17 inhibitors (IL-17i) for patients with high disease activity despite the use (or intolerance/contraindication) of at least two NSAIDs. In addition, they should either have an elevated C reactive protein and/or definite inflammation on MRI and/or radiographic evidence of sacroiliitis. Current practice is to start with a TNFi. Switching to another TNFi or an IL-17i is recommended in case TNFi fails (recommendation 10). Tapering, but not stopping a bDMARD, can be considered in patients in sustained remission (recommendation 11). The final two recommendations (12, 13) deal with surgery and spinal fractures. The 2016 Assessment of SpondyloArthritis international Society-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.
Collapse
Affiliation(s)
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert Landewé
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Filip Van den Bosch
- Department of Rheumatology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Andrea Regel
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, Zurich Switzerland
| | | | - Maxime Dougados
- Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| | - Floris van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pál Géher
- Semmelweis University, Budapest, Hungary
| | | | | | | | - Uta Kiltz
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Pedro M Machado
- Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
| | - Anna Molto
- Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| | | | - Salih Ozgocmen
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | | | - John Reveille
- The University of Texas-Health McGovern Medical School, Dallas, USA
| | - Martin Rudwaleit
- Klinikum Bielefeld, Bielefeld, Germany
- Gent University, Gent, Belgium
- Charité University Medicine, Berlin, Germany
| | - Jochen Sieper
- Department of Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany
| | | | - Dieter Wiek
- EULAR PARE Patient Research Partner and Chair of EULAR PARE, Berlin, Germany
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
| |
Collapse
|