Artikel
2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis
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Autoren
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Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne
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Sofia Ramiro
- Leiden University Medical Centre, Department of Rheumatology, Leiden, The Netherlands
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Robert Landewé
- Academic Medical Center, Department of Internal Medicine, Division of Rheumatology, Amsterdam, Heerlen, The Netherlands
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Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Herne
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Filip van den Bosch
- Universitair Ziekenhuis, Gent, Belgium
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Alexandre Sepriano
- Leiden University Medical Centre, Department of Rheumatology, Leiden, The Netherlands
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Andrea Regel
- Rheumazentrum Ruhrgebiet, Herne
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Adrian Ciurea
- Universitätsspital Zürich, Klinik für Rheumatologie, Zürich, Schweiz
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Hanne Dagfinrud
- University of Oslo - Faculty of Medicine, Sports Medicine, Rehabilitation Medicine, Orthopedic Surgery, Oslo, Norwegen
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Maxime Dougados
- Hôpital Cochin, Department of Rheumatology, Paris, France
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Floris van Gaalen
- Leiden University Medical Centre, Leiden, The Netherlands
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Pál Géher
- Semmelweis University, Third Department of Internal Medicine, Busapest, Hungary
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Irene van der Horst-Bruinsma
- VU Medical Center, Amsterdam
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Robert Inman
- University of Toronto, Toronto, Canada
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Merryn Jonkees
- Eular/Asas/Omeract, Voorschoten, The Netherlands
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Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne
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Tore Kvien
- University of Oslo - Faculty of Medicine, Institute of Clinical Madicine, Oslo, Norway
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Pedro Machado
- Leiden University Medical Centre, Department of Rheumatology, Leiden, The Netherlands
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Helena Marzo-Ortega
- University of Leeds, Leeds, United Kingdom
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Anna Molto
- Hôpital Cochin, Department of Rheumatology, Paris, France
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Victoria Navarro-Compan
- University Hospital La Paz, Madrid, Spain
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Salih Özgözmen
- Erciyes Üniversitesi, Kayseri, Turkey
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Fernando Pimentel dos Santos
- Serviço de Reumatologia - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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John Reveille
- University of Texas, Texas, United States of America
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Martin Rudwaleit
- Klinikum Bielefeld Rosenhöhe, Bielefeld
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Joachim Sieper
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektologie, Rheumatologie, Berlin
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Percival Sampaio Barros
- Hospital Sírio-Libanês, Reumatologia, São Paulo, Brasil
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Dieter Wiek
- Rheuma-Liga Nordrhein-Westfalen e. V., Essen
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Desiree van der Heijde
- Leiden University Medical Center, Department of Rheumatology, Leiden, The Netherlands
| Veröffentlicht: | 29. August 2016 |
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Gliederung
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Background: In 2010 the latest ASAS-EULAR recommendations for ankylosing spondylitis and the ASAS recommendations for the use of TNF-inhibitors (TNFi) have been published. Since then new treatments for axial Spondyloarthritis (axSpA) have become available.
Aim: To update and integrate the two sets of recommendations into one set applicable to patients with axSpA.
Methods: The EULAR Standardised Operating Procedures have been followed. First, two Systematic Literature Reviews have been performed to update the evidence on all treatment options (pharmacological and non-pharmacological) since 2009. The results have been presented during a one-day meeting of the task force. Thereafter, overarching principles and recommendations were updated by a process of achieving consensus and voting.
Results: A total of 5 overarching principles and 13 recommendations have been formulated. The first 3 recommendations deal with personalised medicine including treatment target and monitoring. Recommendation 4 deals with non-pharmacological management. Recommendation 5 describes the central role of NSAIDs as first pharmacological treatment. Recommendations 6 to 8 define the limited place of analgesics, glucocorticoids and conventional synthetic DMARDs. Biological DMARDs (bDMARDs) include TNF- and IL17-inhibitors and are indicated in patients diagnosed with axSpa by a rheumatologist, who have radiographic sacroiliitis and/or inflammation on MRI and/or an elevated CRP-level. Patients should also have high disease activity despite the use of -or intolerance for- at least 2 NSAIDs. High disease activity is defined as an ASDAS ≥2.1 or BASDAI ≥4 and an indication to start a bDMARD by a rheumatologist. The continuation of a bDMARD should be considered if an improvement of ASDAS ≥1.1 or BASDAI ≥2 has been achieved after at least 12 weeks. Current practice is to start with a TNFi. Switching to another TNFi or an IL-17i is recommended in case of failure of TNFi treatment. Tapering -but not stopping- of a bDMARD can be considered in patients with sustained remission. The final two recommendations deal with surgery and fractures.
Conclusion: The 2016 ASAS-EULAR recommendations provide up-to-date guidance on management of patients with axSpA.
