Major Finding: A panel organized by the ASAS and EULAR issued recommendations for the management of ankylosing spondylitis.
Data Source: A series of 11 specific management recommendations developed by a 25-member panel that met for 2 days in February in Zurich.
Disclosures: Dr. Braun has received research support from, been a consultant to, and served as a speaker for Abbott Laboratories, Amgen Inc., Bristol-Myers Squibb Co., Centocor Inc., Merck/Schering-Plough Pharmaceuticals, Merck Sharp & Dohme Corp., Novartis, Pfizer Inc./Wyeth, and Roche.
ROME — Revised recommendations for the management of ankylosing spondylitis from two international societies set tumor necrosis factor inhibitors as the cornerstone of treatment for patients who fail to have an adequate response to treatment with nonsteroidal anti-inflammatory drugs.
The new recommendations also put new emphasis on the extra-articular manifestations of ankylosing spondylitis (AS)—including psoriasis, uveitis, and inflammatory bowel disease (IBD)—and stress that these manifestations should be managed in collaboration with other specialists, along with recognition that AS patients also face increased risks for cardiovascular disease and osteoporosis, Dr. Jürgen Braun said at the annual congress.
AS patients who present with psoriasis, uveitis, or inflammatory bowel disease may do better on a monoclonal antibody–based TNF inhibitor because those forms seem to work better on the extra-articular manifestations than do soluble receptor–based TNF inhibitors, Dr. Braun said in an interview.
On the other hand, soluble receptor–based anti-TNF drugs appear to be somewhat safer, in that they appear to pose a reduced risk for activating either latent tuberculosis or herpes zoster infections, he said.
In the treatment of AS, the main difference “compared with rheumatoid arthritis is that conventional disease-modifying antirheumatic drugs [DMARDs] do not work for axial symptoms,” which exist in the majority of AS patients. “This makes TNF inhibitors almost first-line agents, after [NSAIDs]. All TNF inhibitors work similarly well for the spine, peripheral joints, and entheses.” For AS patients whose major problem is peripheral joint disease, a conventional DMARD—specifically sulfasalazine—can be effective, said Dr. Braun, director of the Center for Rheumatic Diseases in Herne, Germany.
The new treatment guidelines complement the new classification criteria for AS and axial spondyloarthritis that were published by the ASAS (Assessment of Spondyloarthritis International Association) last year (Ann. Rheum. Dis. 2009;68:777–83).
The new classification criteria mean that rheumatologists can “treat when they see inflammation on MRI” instead of having to wait for patients to develop radiographic changes, Dr. Braun noted.
The new classification criteria—coupled with the new treatment recommendations—put treatment on a faster track, and give physicians backup to put those AS patients who don't respond within a few weeks to NSAID therapy on a TNF inhibitor relatively early in the course of their disease.
A panel of 18 rheumatologists, two orthopedic surgeons, one physiotherapist, and four patients formed by ASAS and EULAR (European League Against Rheumatism) devised the new treatment recommendations over 2 days in February in Zurich.
The panel of physicians based their decisions on a review of the published literature since 2005.
The recommendations consist of 11 specific AS management directives that cover everything from general treatment to surgery, and rule out other causes in patients who do respond to standard care.
They will appear in an article the EULAR journal, Annals of the Rheumatic Diseases, in the near future.
To view an interview with Dr. Braun, go to www.youtube.com/elsglobalmedicalnews
Certain subsets of AS patients with uveitis, psoriasis, or IBD do better on monoclonal antibody-based TNF blockers.
Source DR. BRAUN