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

被引：296

作者：

Ward, Michael M. ^{[1
]}

Deodhar, Atul ^{[2
]}

Akl, Elie A. ^{[3
,4
]}

Lui, Andrew ^{[5
]}

Ermann, Joerg ^{[6
]}

Gensler, Lianne S. ^{[5
]}

Smith, Judith A. ^{[7
]}

Borenstein, David ^{[8
]}

Hiratzka, Jayme ^{[2
]}

Weiss, Pamela F. ^{[9
,10
]}

Inman, Robert D. ^{[11
]}

Majithia, Vikas ^{[12
]}

Haroon, Nigil ^{[11
]}

Maksymowych, Walter P. ^{[13
]}

Joyce, Janet ^{[14
]}

Clark, Bruce M. ^{[15
]}

Colbert, Robert A. ^{[1
]}

Figgie, Mark P. ^{[16
]}

Hallegua, David S. ^{[17
]}

Prete, Pamela E. ^{[18
,19
]}

Rosenbaum, James T. ^{[2
,20
]}

Stebulis, Judith A. ^{[21
]}

van den Bosch, Filip ^{[22
]}

Yu, David T. Y. ^{[23
]}

Miller, Amy S. ^{[14
]}

Reveille, John D. ^{[24
]}

Caplan, Liron ^{[25
,26
]}

机构：

[1] NIAMSD, NIH, Bldg 10 CRC,Room 4-1339,10 Ctr Dr, Bethesda, MD 20892 USA

[2] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[3] Amer Univ Beirut, Beirut, Lebanon

[4] McMaster Univ, Hamilton, ON, Canada

[5] Univ Calif San Francisco, San Francisco, CA 94143 USA

[6] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

[7] Univ Wisconsin, Madison, WI 53706 USA

[8] Arthrit & Rheumatism Associates, Washington, DC USA

[9] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[10] Univ Penn, Philadelphia, PA 19104 USA

[11] Univ Toronto, Toronto, ON, Canada

[12] Univ Mississippi, Med Ctr, Jackson, MS USA

[13] Univ Alberta, Edmonton, AB, Canada

[14] Amer Coll Rheumatol, 60 Execut Pk S,Suite 150, Atlanta, GA 30329 USA

[15] RPT, Vancouver, BC, Canada

[16] Hosp Special Surg, 535 E 70th St, New York, NY 10021 USA

[17] Cedars Sinai Med Ctr, Beverly Hills, CA USA

[18] VA Long Beach Med Ctr, Long Beach, CA USA

[19] Univ Calif Irvine, Irvine, CA USA

[20] Legacy Devers Eye Inst, Portland, OR USA

[21] Univ Massachusetts, Worcester, MA 01605 USA

[22] Univ Ghent, B-9000 Ghent, Belgium

[23] Univ Calif Los Angeles, Los Angeles, CA USA

[24] Univ Texas Hlth Sci Ctr Houston, Houston, TX 77030 USA

[25] Denver VA Med Ctr, Denver, CO USA

[26] Univ Colorado, Aurora, CO USA

来源：

ARTHRITIS & RHEUMATOLOGY | 2016年 / 68卷 / 02期

关键词：

INFLAMMATORY-BOWEL-DISEASE; CLASSIFICATION CRITERIA; PSORIATIC-ARTHRITIS; MANAGEMENT; EFFICACY; SAFETY; INJECTIONS; THERAPY; DRUGS; GRADE;

D O I：

10.1002/art.39298

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：282 / 298

页数：17

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