• Something wrong with this record ?

ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update

S. Ramiro, E. Nikiphorou, A. Sepriano, A. Ortolan, C. Webers, X. Baraliakos, RBM. Landewé, FE. Van den Bosch, B. Boteva, A. Bremander, P. Carron, A. Ciurea, FA. van Gaalen, P. Géher, L. Gensler, J. Hermann, M. de Hooge, M. Husakova, U. Kiltz, C....

. 2023 ; 82 (1) : 19-34. [pub] 20221021

Language English Country England, Great Britain

Document type Journal Article, Research Support, Non-U.S. Gov't

Persistent link   https://www.medvik.cz/link/bmc23004799

OBJECTIVES: To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). METHODS: Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. RESULTS: Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6-8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. CONCLUSIONS: The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.

1st Faculty of Medicine Charles University and Rheumatology Institute Prague Czech Republic

Center for Rheumatic Diseases King's College London London UK

Centre for Rheumatology and Department of Neuromuscular Diseases University College London London UK

Danish Hospital for Rheumatic Diseases University Hospital of Southern Denmark Sønderborg Denmark

Department of Internal Medicine Division of Rheumatology Maastricht University Medical Centre Maastricht The Netherlands

Department of Rheumatology Zuyderland Medical Center Heerlen The Netherlands

Division of Rheumatology University of California San Francisco San Francisco California USA

Faculty of Biology Medicine and Health The University of Manchester Manchester UK

Gastroenterology Infectious Diseases and Rheumatology Charité Universitätsmedizin Berlin Berlin Germany

Internal Medicine and Pediatrics Ghent University VIB Center for Inflammation Research Ghent Belgium

Internal Medicine and Rheumatology Klinikum Bielefeld Rosenhöhe Bielefeld Germany

Internal Medicine Division of Rheumatology and Immunology Medical University Graz Graz Austria

Lund University Lund Sweden

Maimonides Biomedical Research Institute of Cordoba Cordoba Spain

NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Disease University of Leeds Leeds UK

NIHR University College London Hospitals Biomedical Research Centre University College London Hospitals NHS Foundation Trust London UK

Nova Medical School CHRC Campus Lisbon Portugal

Patient Research Partner European Alliance of Associations for Rheumatology Sofia Bulgaria

Patients with Arthritis and Rheumatism working group European Alliance of Associations for Rheumatology Patient Research Partner Oxford UK

Rheumatology and Clinical Immunology Amsterdam University Medical Center Amsterdam The Netherlands

Rheumatology Geneva University Hospital Geneva Switzerland

Rheumatology Ghent University Hospital Ghent Belgium

Rheumatology Hotel Dieu De France Achrafieh Lebanon

Rheumatology Leiden University Medical Center Leiden The Netherlands

Rheumatology Northwick Park Hospital London North West University Healthcare NHS Trust London UK

Rheumatology Paris Descartes University Cochin Hospital AP HP and INSERM PRES Sorbonne Paris Cité Université Paris Cité Paris France

Rheumatology Reina Sofia University Hospital Cordoba Spain

Rheumatology Saint Joseph University Beirut Lebanon

Rheumatology Unit Department of Medicine DIMED University of Padova Padua Italy

Rheumatology University Hospital La Paz IdiPaz Madrid Spain

Rheumatology University Hospital Zurich Zurich Switzerland

Rheumatology Zuyderland Medical Center Heerlen The Netherlands

Rheumazentrum Ruhrgebiet Ruhr University Bochum Herne Germany

Semmelweis University Budapest Hungary

References provided by Crossref.org

000      
00000naa a2200000 a 4500
001      
bmc23004799
003      
CZ-PrNML
005      
20230425171727.0
007      
ta
008      
230418s2023 enk f 000 0|eng||
009      
AR
024    7_
$a 10.1136/ard-2022-223296 $2 doi
035    __
$a (PubMed)36270658
040    __
$a ABA008 $b cze $d ABA008 $e AACR2
041    0_
$a eng
044    __
$a enk
100    1_
$a Ramiro, Sofia $u Rheumatology, Leiden University Medical Center, Leiden, The Netherlands sofiaramiro@gmail.com $u Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands $1 https://orcid.org/0000000288999087
245    10
$a ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update / $c S. Ramiro, E. Nikiphorou, A. Sepriano, A. Ortolan, C. Webers, X. Baraliakos, RBM. Landewé, FE. Van den Bosch, B. Boteva, A. Bremander, P. Carron, A. Ciurea, FA. van Gaalen, P. Géher, L. Gensler, J. Hermann, M. de Hooge, M. Husakova, U. Kiltz, C. López-Medina, PM. Machado, H. Marzo-Ortega, A. Molto, V. Navarro-Compán, MJ. Nissen, FM. Pimentel-Santos, D. Poddubnyy, F. Proft, M. Rudwaleit, M. Telkman, SS. Zhao, N. Ziade, D. van der Heijde
520    9_
$a OBJECTIVES: To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). METHODS: Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. RESULTS: Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6-8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. CONCLUSIONS: The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.
650    _2
$a lidé $7 D006801
650    12
$a antirevmatika $x terapeutické užití $7 D018501
650    _2
$a antiflogistika nesteroidní $x terapeutické užití $7 D000894
650    12
$a spondylartritida $x farmakoterapie $7 D025241
650    12
$a ankylózující spondylitida $x farmakoterapie $7 D013167
650    _2
$a analgetika $x terapeutické užití $7 D000700
655    _2
$a časopisecké články $7 D016428
655    _2
$a práce podpořená grantem $7 D013485
700    1_
$a Nikiphorou, Elena $u Rheumatology, Leiden University Medical Center, Leiden, The Netherlands $u Center for Rheumatic Diseases, King's College London, London, UK $1 https://orcid.org/0000000168473726
700    1_
$a Sepriano, Alexandre $u Rheumatology, Leiden University Medical Center, Leiden, The Netherlands $u Nova Medical School, CHRC Campus, Lisbon, Portugal $1 https://orcid.org/0000000319540229
700    1_
$a Ortolan, Augusta $u Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy $1 https://orcid.org/0000000231310939
700    1_
$a Webers, Casper $u Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands $1 https://orcid.org/0000000330118547
700    1_
$a Baraliakos, Xenofon $u Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
700    1_
$a Landewé, Robert B M $u Rheumatology & Clinical Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands $u Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands $1 https://orcid.org/0000000205776620
700    1_
$a Van den Bosch, Filip E $u Internal Medicine and Pediatrics, Ghent University-VIB Center for Inflammation Research, Ghent, Belgium $u Rheumatology, Ghent University Hospital, Ghent, Belgium $1 https://orcid.org/0000000235615932
700    1_
$a Boteva, Boryana $u Patient Research Partner, European Alliance of Associations for Rheumatology, Sofia, Bulgaria
700    1_
$a Bremander, Ann $u Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark $u Lund University, Lund, Sweden
700    1_
$a Carron, Philippe $u Internal Medicine and Pediatrics, Ghent University-VIB Center for Inflammation Research, Ghent, Belgium $u Rheumatology, Ghent University Hospital, Ghent, Belgium $1 https://orcid.org/0000000192546171
700    1_
$a Ciurea, Adrian $u Rheumatology, University Hospital Zurich, Zurich, Switzerland $1 https://orcid.org/0000000278707132
700    1_
$a van Gaalen, Floris A $u Rheumatology, Leiden University Medical Center, Leiden, The Netherlands $1 https://orcid.org/0000000184487407
700    1_
$a Géher, Pál $u Semmelweis University, Budapest, Hungary
700    1_
$a Gensler, Lianne $u Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
700    1_
$a Hermann, Josef $u Internal Medicine, Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
700    1_
$a de Hooge, Manouk $u Internal Medicine and Pediatrics, Ghent University-VIB Center for Inflammation Research, Ghent, Belgium $1 https://orcid.org/0000000206529808
700    1_
$a Husakova, Marketa $u First Faculty of Medicine Charles University and Rheumatology Institute, Prague, Czech Republic
700    1_
$a Kiltz, Uta $u Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany $1 https://orcid.org/0000000156684497
700    1_
$a López-Medina, Clementina $u Rheumatology, Reina Sofia University Hospital, Cordoba, Spain $u Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain $1 https://orcid.org/0000000223095837
700    1_
$a Machado, Pedro M $u Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK $u NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals (UCLH) NHS Foundation Trust, London, UK $u Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK $1 https://orcid.org/0000000284117972
700    1_
$a Marzo-Ortega, Helena $u NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
700    1_
$a Molto, Anna $u Rheumatology, Paris Descartes University, Cochin Hospital, AP-HP, and INSERM (U1153), PRES Sorbonne Paris-Cité, Université Paris-Cité, Paris, France $1 https://orcid.org/0000000322461986
700    1_
$a Navarro-Compán, Victoria $u Rheumatology, University Hospital La Paz, IdiPaz, Madrid, Spain $1 https://orcid.org/000000024527852X
700    1_
$a Nissen, Michael J $u Rheumatology, Geneva University Hospital, Geneva, Switzerland $1 https://orcid.org/0000000263261764
700    1_
$a Pimentel-Santos, Fernando M $u Nova Medical School, CHRC Campus, Lisbon, Portugal
700    1_
$a Poddubnyy, Denis $u Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany $1 https://orcid.org/0000000245376015
700    1_
$a Proft, Fabian $u Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany $1 https://orcid.org/000000034306033X
700    1_
$a Rudwaleit, Martin $u Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany $1 https://orcid.org/000000015445548X
700    1_
$a Telkman, Mark $u Patients with Arthritis and Rheumatism (PARE) working group, European Alliance of Associations for Rheumatology, Patient Research Partner, Oxford, UK
700    1_
$a Zhao, Sizheng Steven $u Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK $1 https://orcid.org/0000000235587353
700    1_
$a Ziade, Nelly $u Rheumatology, Hotel-Dieu De France, Achrafieh, Lebanon $u Rheumatology, Saint Joseph University, Beirut, Lebanon $1 https://orcid.org/0000000244797678
700    1_
$a van der Heijde, Désirée $u Rheumatology, Leiden University Medical Center, Leiden, The Netherlands $1 https://orcid.org/000000025781158X
773    0_
$w MED00000444 $t Annals of the rheumatic diseases $x 1468-2060 $g Roč. 82, č. 1 (2023), s. 19-34
856    41
$u https://pubmed.ncbi.nlm.nih.gov/36270658 $y Pubmed
910    __
$a ABA008 $b sig $c sign $y p $z 0
990    __
$a 20230418 $b ABA008
991    __
$a 20230425171724 $b ABA008
999    __
$a ok $b bmc $g 1925095 $s 1191008
BAS    __
$a 3
BAS    __
$a PreBMC-MEDLINE
BMC    __
$a 2023 $b 82 $c 1 $d 19-34 $e 20221021 $i 1468-2060 $m Annals of the rheumatic diseases $n Ann Rheum Dis $x MED00000444
LZP    __
$a Pubmed-20230418

Find record

Citation metrics

Archiving options