Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Ramiro, S; Nikiphorou, E; Sepriano, A; Ortolan, A; Webers, C; Baraliakos, X; Landewé, RBM; Van, den, Bosch, FE; Boteva, B; Bremander, A; Carron, P; Ciurea, A; van, Gaalen, FA; Géher, P; Gensler, L; Hermann, J; de, Hooge, M; Husakova, M; Kiltz, U; López-Medina, C; Machado, PM; Marzo-Ortega, H; Molto, A; Navarro-Compán, V; Nissen, MJ; Pimentel-Santos, FM; Poddubnyy, D; Proft, F; Rudwaleit, M; Telkman, M; Zhao, SS; Ziade, N; van, der, Heijde, D.
ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update.
Ann Rheum Dis. 2023; 82(1):19-34
Doi: 10.1136/ard-2022-223296
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- Co-Autor*innen der Med Uni Graz
- Hermann Josef
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- 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 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.
- Find related publications in this database (using NLM MeSH Indexing)
- Humans - administration & dosage
- Antirheumatic Agents - therapeutic use
- Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
- Spondylarthritis - drug therapy
- Spondylitis, Ankylosing - drug therapy
- Analgesics - therapeutic use
- Find related publications in this database (Keywords)
- Spondyloarthritis
- Biological Therapy
- Therapeutics