ASAS-EULAR recommendations for the management of axial spondyloarthritis : 2022 update
(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.
(Less)
- author
- organization
- publishing date
- 2022-10
- 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}}, }