American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

Abstract

Objective To provide evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). Methods A core group led the development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946–2014), PubMed (1966–2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework. Results In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS. Conclusion These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas.

Impact of a multidisciplinary approach in enteropathic spondyloarthritis patients

“…HLA testing represents the most useful laboratory evaluation in appropriately selected patients. The recommendations for the treatment of active SpA included use of NSAIDs, use of TNF-inhibitors (TNF-i) when activity persists despite NSAID treatment, avoid systemic glucocorticoids, use of physical therapy and hip arthroplasty for patients with advanced hip arthritis [21]. No particular TNFi was suggested except in patients with concomitant IBD or recurrent iritis, in whom TNFi monoclonal antibodies should be preferred [21].…”

“…The recommendations for the treatment of active SpA included use of NSAIDs, use of TNF-inhibitors (TNF-i) when activity persists despite NSAID treatment, avoid systemic glucocorticoids, use of physical therapy and hip arthroplasty for patients with advanced hip arthritis [21]. No particular TNFi was suggested except in patients with concomitant IBD or recurrent iritis, in whom TNFi monoclonal antibodies should be preferred [21]. In patients with active nr-ax SpA despite treatment with NSAIDs, it is conditionally recommended treatment with TNFi [21].…”

Celecoxib for the Treatment of Ankylosing Spondylitis

“…The American College of Rheumatology (ACR) guidelines [4] are similar, also strongly recommending ongoing treatment with NSAIDs and physical therapy. In the ACR guidelines, anti-TNF therapy is strongly recommended in patients who do not respond to NSAIDs as is surgery for more severe patients, while the guidelines strongly recommended against the use of systemic…”

“…It is a disease of young people, generally presenting around 26 years of age, [2] and being more common in men than women with one study reporting a ratio of males to females of 2.4:1 [3]. Treatment aims to reduce symptoms, maintain flexibility and posture, and retard structural damage [4,5]. There is no cure but European and North American treatment guidelines recommend physical therapy/exercise in combination with non-steroidal anti-inflammatory drugs (NSAIDs), including COX-2 selective inhibitors as first-line treatment [4,5].…”

“…This publication outlines the key role of inflammation in ankylosing spondylitis and reviews the available data on the safety and efficacy of the COX-2 selective inhibitor celecoxib, one glucocorticoids [4].…”