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

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

Jazyk angličtina Země Spojené státy americké Médium print-electronic

Typ dokumentu časopisecké články, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/pmid36270658
Odkazy

PubMed 36270658
DOI 10.1136/ard-2022-223296
PII: S0003-4967(24)08620-5
Knihovny.cz E-zdroje

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

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