ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články, práce podpořená grantem
PubMed
36270658
DOI
10.1136/ard-2022-223296
PII: S0003-4967(24)08620-5
Knihovny.cz E-zdroje
- Klíčová slova
- Biological Therapy, Spondyloarthritis, Therapeutics,
- MeSH
- analgetika terapeutické užití MeSH
- ankylózující spondylitida * farmakoterapie MeSH
- antiflogistika nesteroidní terapeutické užití MeSH
- antirevmatika * terapeutické užití MeSH
- lidé MeSH
- spondylartritida * farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- analgetika MeSH
- antiflogistika nesteroidní MeSH
- antirevmatika * MeSH
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 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
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
Maimonides Biomedical Research Institute of Cordoba Cordoba Spain
Nova Medical School CHRC Campus Lisbon Portugal
Patient Research Partner European Alliance of Associations for Rheumatology Sofia Bulgaria
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 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
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