2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis

Abstract

This first update of the ASAS/EULAR recommendations on the management of ankylosing spondylitis (AS) is based on the original paper, a systematic review of existing recommendations and the literature since 2005 and the discussion and agreement among 21 international experts, 2 patients and 2 physiotherapists in a meeting in February 2010. Each original bullet point was discussed in detail and reworded if necessary. Decisions on new recommendations were made — if necessary after voting. The strength of the recommendations (SOR) was scored on an 11-point numerical rating scale after the meeting by email. These recommendations apply to patients of all ages that fulfill the modified NY criteria for AS, independent of extra-articular manifestations, and they take into account all drug and non-drug interventions related to AS. Four overarching principles were introduced, implying that one bullet has been moved to this section. There are now 11 bullet points including 2 new ones, one related to extra-articular manifestations and one to changes in the disease course. With a mean score of 9.1 (range 8-10) the SOR was generally very good.

Real Life Experience of First Course of Anti-TNF Treatment in Ankylosing Spondylitis Patients in Brazil

“…In our study, 36.8% of patients were using corticosteroids on baseline and 26.9% were still using corticosteroids after 12 months of follow-up, probably to treat peripheral or extra-articular manifestations, since the use of corticosteroids for axial disease is not supported by current evidence [3,22]. However, we could not confirm this supposition because we did not address the reasons for corticosteroid use in our study.…”

“…Anti-tumor necrosis factor (anti-TNF) drugs are recommended as therapy for patients with high disease activity despite the first-line treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) [3]. Randomized clinical trials and observational studies have shown that patients treated with anti-TNF agents experience a decrease in disease activity and better functionality [4].…”

Real-life experience with switching TNF-α inhibitors in ankylosing spondylitis

“…On the basis of ASAS guideline, those AS patients are eligible for TNFi therapy who has active disease as determined by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and do not respond to at least two NSAIDs (6). Although the ASAS/European League Against Rheumatism (EULAR) recommendation clearly states that there are no differences in efficacy among the TNFi-s on the axial and articular/entheseal disease manifestations (7), it has been documented in several clinical trials that the anti-TNF monoclonal antibodies (adalimumab, infliximab and golimumab) can be used successfully in the treatment of most common extra-articular manifestations of the disease, while etanercept has milder effect on uveitis and inflammatory bowel diseases (8;9). According to these observations the difference in gastrointestinal efficacy of each TNFi-s is suggested to be taken into account by ASAS/EULAR guidelines (7), but beyond this aspect there are no therapeutic recommendations how to choose between TNFis or how to switch between these agents.…”

Histopathological changes in supraspinous ligaments, ligamentum flava and paraspinal muscle tissues of patients with ankylosing spondylitis

“…2 The treatment of patients with AS should be individualized according to the current manifestations of the disease (encompassing axial, peripheral, entheseal and extra-articular symptoms and signs), the level of current symptoms, clinical findings, and prognostic indicators, as well as general clinical status (age, gender, comorbidity, concomitant medications, psychosocial factors). 3 Although the pathogenesis of AS is not entirely known, inflammation and new bone formation, especially in the spine, have been suggested to contribute to AS. 2,4 Supraspinous ligaments and ligamentum flava are the main targets of ossification, contributing to the pathological changes of AS.…”