The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis – 2019

Abstract

Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013. A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed. These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis. The purpose of these guidelines is to bring evidencebased information on clinical management of axial SpA patients, including, diagnosis, treatment and prognosis, for rheumatologists, general physicians, allied-specialists (dermatology, ophthalmology and gastroenterology), and other allied-professionals, such as physiotherapists. This version replaces the previous guidelines published on May 26, 2013 [3] and should be updated every 4 years. Methods A systematic literature review was performed, with external review of an specialized group of the Brazilian

Brazilian recommendations for the use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis

“…The most recently published guidelines for the management of axSpA recommended NSAIDs as the first line treatment, but none of them has addressed specifically the current role of NSAIDs in the treatment of patients with axSpA regarding efficacy, safety and therapeutic strategy [6,7,71]. The present systematic review and critical analysis of the available evidences have confirmed that NSAIDs are still the basis for the treatment of patients with axSpA, as they are effective in most part of those patients.…”

“…Based on the previous guidelines for the treatment of axSpA and the clinical experience, despite lack of evidence, the panel recommended a second NSAI D, regardless therapeutic class (selective COX-2 or not), could be used if the first one failed after 4 weeks. The total treatment period with NSAIDs should not exceed 12 weeks, if the predefined target is not achieved [6,7].…”

“…Despite the lack of evidence, the panel recommended continuous use of NSAIDs in active disease until symptoms relief is achieved, based on the previous guidelines and the clinical experience [6,7,71].…”

“…Recently, the Brazilian Society of Rheumatology has published evidence based recommendations for the diagnosis and management of axSpA [7]. Our main goal in the present guideline was to specifically evaluate the role of NSAIDs for treating axSpA patients through a systematic review with meta-analysis and critical analysis of the published scientific data.…”

Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Axial Spondyloarthritis 2021

“…In patients with disease controlled with original anti-TNF or anti-IL-17, it is not recommended to change therapy with biosimilar products 31. This is related to the risk of differences in the therapeutic response of the original product with biosimilar products in terms of efficacy, safety, and tolerability in patients 32.…”