Author(s):
Ramiro, Sofia ; Nikiphorou, Elena ; Sepriano, Alexandre ; Ortolan, Augusta ; Webers, Casper ; Baraliakos, Xenofon ; Landewé, Robert B.M. ; Van Den Bosch, Filip E. ; Boteva, Boryana ; Bremander, Ann ; Carron, Philippe ; Ciurea, Adrian ; Van Gaalen, Floris A. ; Géher, Pál ; Gensler, Lianne ; Hermann, Josef ; De Hooge, Manouk ; Husakova, Marketa ; Kiltz, Uta ; López-Medina, Clementina ; Machado, Pedro M. ; Marzo-Ortega, Helena ; Molto, Anna ; Navarro-Compán, Victoria ; Nissen, Michael J. ; M. Pimentel-Santos, F. ; Poddubnyy, Denis ; Proft, Fabian ; Rudwaleit, Martin ; Telkman, Mark ; Zhao, Sizheng Steven ; Ziade, Nelly ; Van Der Heijde, Désirée
Date: 2022
Persistent ID: http://hdl.handle.net/10362/147366
Origin: Repositório Institucional da UNL
Subject(s): Biological Therapy; Spondyloarthritis; Therapeutics; Rheumatology; Immunology and Allergy; Immunology; Biochemistry, Genetics and Molecular Biology(all)
Description
Funding EULAR and Assessment of SpondyloArthritis international Society (ASAS).
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.
