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

Ramiro, Sofia ; Nikiphorou, Elena ; Sepriano, Alexandre ; Ortolan, Augusta ; Webers, Casper ; Baraliakos, Xenofon ; Landewé, Robert B.M. ; Van Den Bosch, Filip E. ; Boteva, Boryana and Bremander, Ann LU , et al. (2022) In Annals of the Rheumatic Diseases 82(1). p.19-34
Abstract

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... (More)

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.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Biological Therapy, Spondyloarthritis, Therapeutics
in
Annals of the Rheumatic Diseases
volume
82
issue
1
pages
16 pages
publisher
BMJ Publishing Group
external identifiers
  • pmid:36270658
  • scopus:85142060542
ISSN
0003-4967
DOI
10.1136/ard-2022-223296
language
English
LU publication?
yes
id
b6ebc526-c081-411b-8ed8-7307dd3c7b1b
date added to LUP
2023-02-08 15:12:43
date last changed
2024-04-29 19:25:53
@article{b6ebc526-c081-411b-8ed8-7307dd3c7b1b,
  abstract     = {{<p>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.</p>}},
  author       = {{Ramiro, Sofia and Nikiphorou, Elena and Sepriano, Alexandre and Ortolan, Augusta and Webers, Casper and Baraliakos, Xenofon and Landewé, Robert B.M. and Van Den Bosch, Filip E. and Boteva, Boryana and Bremander, Ann and Carron, Philippe and Ciurea, Adrian and Van Gaalen, Floris A. and Géher, Pál and Gensler, Lianne and Hermann, Josef and De Hooge, Manouk and Husakova, Marketa and Kiltz, Uta and López-Medina, Clementina and Machado, Pedro M. and Marzo-Ortega, Helena and Molto, Anna and Navarro-Compán, Victoria and Nissen, Michael J. and Pimentel-Santos, Fernando M. and Poddubnyy, Denis and Proft, Fabian and Rudwaleit, Martin and Telkman, Mark and Zhao, Sizheng Steven and Ziade, Nelly and Van Der Heijde, Désirée}},
  issn         = {{0003-4967}},
  keywords     = {{Biological Therapy; Spondyloarthritis; Therapeutics}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{19--34}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Annals of the Rheumatic Diseases}},
  title        = {{ASAS-EULAR recommendations for the management of axial spondyloarthritis : 2022 update}},
  url          = {{http://dx.doi.org/10.1136/ard-2022-223296}},
  doi          = {{10.1136/ard-2022-223296}},
  volume       = {{82}},
  year         = {{2022}},
}