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American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis.
Arthritis Rheumatol. 2016 Feb; 68(2):282-98.AR

Abstract

OBJECTIVE

To provide evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).

METHODS

A core group led the development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946-2014), PubMed (1966-2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework.

RESULTS

In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS.

CONCLUSION

These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas.

Authors+Show Affiliations

National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland.Oregon Health & Science University, Portland.American University of Beirut, Beirut, Lebanon, and McMaster University, Hamilton, Ontario, Canada.University of California, San Francisco.Brigham and Women's Hospital, Boston, Massachusetts.University of California, San Francisco.University of Wisconsin, Madison.Arthritis and Rheumatism Associates, Washington, DC.Oregon Health & Science University, Portland.Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia.University of Toronto, Toronto, Ontario, Canada.University of Mississippi Medical Center, Jackson.University of Toronto, Toronto, Ontario, Canada.University of Alberta, Edmonton, Alberta, Canada.American College of Rheumatology, Atlanta, Georgia.Vancouver, British Columbia, Canada.National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland.Hospital for Special Surgery, New York, New York.Cedars-Sinai Medical Center, Beverly Hills, California.VA Long Beach Medical Center, Long Beach, California, and University of California, Irvine.Oregon Health & Science University and Legacy Devers Eye Institute, Portland.University of Massachusetts, Worcester.University of Ghent, Ghent, Belgium.University of California, Los Angeles.American College of Rheumatology, Atlanta, Georgia.University of Texas Health Sciences Center at Houston.Denver VA Medical Center, Denver, Colorado, and University of Colorado, Aurora.

Pub Type(s)

Journal Article
Practice Guideline
Research Support, N.I.H., Intramural

Language

eng

PubMed ID

26401991

Citation

Ward, Michael M., et al. "American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis." Arthritis & Rheumatology (Hoboken, N.J.), vol. 68, no. 2, 2016, pp. 282-98.
Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2016;68(2):282-98.
Ward, M. M., Deodhar, A., Akl, E. A., Lui, A., Ermann, J., Gensler, L. S., Smith, J. A., Borenstein, D., Hiratzka, J., Weiss, P. F., Inman, R. D., Majithia, V., Haroon, N., Maksymowych, W. P., Joyce, J., Clark, B. M., Colbert, R. A., Figgie, M. P., Hallegua, D. S., ... Caplan, L. (2016). American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis & Rheumatology (Hoboken, N.J.), 68(2), 282-98. https://doi.org/10.1002/art.39298
Ward MM, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2016;68(2):282-98. PubMed PMID: 26401991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. AU - Ward,Michael M, AU - Deodhar,Atul, AU - Akl,Elie A, AU - Lui,Andrew, AU - Ermann,Joerg, AU - Gensler,Lianne S, AU - Smith,Judith A, AU - Borenstein,David, AU - Hiratzka,Jayme, AU - Weiss,Pamela F, AU - Inman,Robert D, AU - Majithia,Vikas, AU - Haroon,Nigil, AU - Maksymowych,Walter P, AU - Joyce,Janet, AU - Clark,Bruce M, AU - Colbert,Robert A, AU - Figgie,Mark P, AU - Hallegua,David S, AU - Prete,Pamela E, AU - Rosenbaum,James T, AU - Stebulis,Judith A, AU - van den Bosch,Filip, AU - Yu,David T Y, AU - Miller,Amy S, AU - Reveille,John D, AU - Caplan,Liron, Y1 - 2015/09/24/ PY - 2014/12/16/received PY - 2015/07/21/accepted PY - 2015/9/25/entrez PY - 2015/9/25/pubmed PY - 2016/6/15/medline SP - 282 EP - 98 JF - Arthritis & rheumatology (Hoboken, N.J.) JO - Arthritis Rheumatol VL - 68 IS - 2 N2 - OBJECTIVE: To provide evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). METHODS: A core group led the development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946-2014), PubMed (1966-2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework. RESULTS: In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS. CONCLUSION: These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas. SN - 2326-5205 UR - https://www.unboundmedicine.com/medline/citation/26401991/American_College_of_Rheumatology/Spondylitis_Association_of_America/Spondyloarthritis_Research_and_Treatment_Network_2015_Recommendations_for_the_Treatment_of_Ankylosing_Spondylitis_and_Nonradiographic_Axial_Spondyloarthritis_ L2 - https://doi.org/10.1002/art.39298 DB - PRIME DP - Unbound Medicine ER -