Revised international guidelines for Ankylosing Spondylitis

Revised international guidelines have recently been released on the use of anti-tumour necrosis factor agents in ankylosing spondylitis. The working group propose the updated consensus statement as a basis for national guidelines.Leading the Assessment in Ankylosing Spondylitis (ASAS) Working Group, Dr J Braun (Rheumazentrum Ruhrgebiet, Herne, Germany) and colleagues issued a questionnaire to ASAS members. Of the 72 working group members, 37 responded. Eighty-seven percent of responders considered the guidelines to be clinically helpful, while two-thirds said they were useful in negotiating with payers. Half of respondents said that they were fully satisfied with the recommendations, while 55% recommended some changes.The minor adjustments to the original consensus statement were to the section of the recommendations addressing failure of standard treatment. The working group sought to clarify that it is not necessary for patients given anti-TNF for axial symptoms to first undergo treatment with DMARDs. Also, the recommendations now state that while patients with peripheral arthritis should first be treated with sulfasalazine, a trial with methotrexate is not necessary.The group also defined that for monitoring anti-TNF treatment, both the ASAS core set for clinical practice and the BASDAI should be followed after the initiation of treatment. Discontinuation of anti-TNF treatment in non-responders should be considered after six to twelve weeks. Response was defined by an improvement of at least 50% or two units (on a 0-10 scale) of the BASDAI.Dr Braun's group advocate that the revised recommendations guide clinical practice and form a basis for developing national guidelines. The working party plans to review and update the guidelines in two years.Reference...