TY - JOUR
T1 - ASAS-EULAR recommendations for the management of axial spondyloarthritis
T2 - 2022 update
AU - Ramiro, Sofia
AU - Nikiphorou, Elena
AU - Sepriano, Alexandre
AU - Ortolan, Augusta
AU - Webers, Casper
AU - Baraliakos, Xenofon
AU - Landewé, Robert B.M.
AU - Van Den Bosch, Filip E.
AU - Boteva, Boryana
AU - Bremander, Ann
AU - Carron, Philippe
AU - Ciurea, Adrian
AU - Van Gaalen, Floris A.
AU - Géher, Pál
AU - Gensler, Lianne
AU - Hermann, Josef
AU - De Hooge, Manouk
AU - Husakova, Marketa
AU - Kiltz, Uta
AU - López-Medina, Clementina
AU - Machado, Pedro M.
AU - Marzo-Ortega, Helena
AU - Molto, Anna
AU - Navarro-Compán, Victoria
AU - Nissen, Michael J.
AU - Pimentel-Santos, Fernando M.
AU - Poddubnyy, Denis
AU - Proft, Fabian
AU - Rudwaleit, Martin
AU - Telkman, Mark
AU - Zhao, Sizheng Steven
AU - Ziade, Nelly
AU - Van Der Heijde, Désirée
N1 - Funding EULAR and Assessment of SpondyloArthritis international Society (ASAS).
PY - 2022/10/21
Y1 - 2022/10/21
N2 - 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.
AB - 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.
KW - Biological Therapy
KW - Spondyloarthritis
KW - Therapeutics
UR - http://www.scopus.com/inward/record.url?scp=85142060542&partnerID=8YFLogxK
U2 - 10.1136/ard-2022-223296
DO - 10.1136/ard-2022-223296
M3 - Article
C2 - 36270658
AN - SCOPUS:85142060542
SN - 0003-4967
VL - 82
SP - 19
EP - 34
JO - Annals of the rheumatic diseases
JF - Annals of the rheumatic diseases
IS - 1
M1 - A78
ER -