EXTENDED REPORT

¹ René Descartes University, Cochin Hospital, Paris. Aix-Marseille II University, Conception Hospital, Marseille, France
² Department of Rheumatology, University Hospital, Maastricht, The Netherlands
³ Royal National Hospital for Rheumatic diseases, Bath, UK
⁴ Department of Medicine, Case Western Reserve University, MetroHealth Medical Center, Division of Rheumatology, Cleveland, OH, USA
⁵ Department of Medicine, University of Queensland, Royal Brisbane Hospital, Queensland, Australia
⁶ Rheumatology B Department, Cochin Hospital, René Descartes University, Paris, France

Correspondence to:
Correspondence to:
Professor M Dougados, Rheumatology B Department, Cochin Hospital, 27 rue du Faubourg Saint Jacques, 75014 Paris, France;
maxime.dougados{at}cch.ap-hop-paris.fr

Background: There is ample evidence of important symptomatic efficacy of tumour necrosis factor (TNF) inhibition in ankylosing spondylitis (AS). Moreover, studies suggest that anti-TNF could be considered as the first disease controlling antirheumatic treatment (DC-ART) for AS.

Objective: To determine precisely which patients with AS are most likely to benefit from anti-TNF treatment because of the cost and possible long term side effects of such treatment.

Methods: Assessment in Ankylosing Spondylitis (ASAS) members were asked to use a Delphi technique to name the characteristics of patients with AS for whom they would start DC-ART, in three different clinical presentations (isolated axial involvement, peripheral arthritis, enthesitis).

Results: Among the 62 invited ASAS members, more than 50% actively participated in the four phases of definition according to the Delphi technique. For each of the three clinical presentations, a combination of five to six domains was proposed, with an evaluation instrument and a cut off point defining a minimum level of activity for each domain.

Conclusion: This study provides a profile for a patient with AS for considering initiation of biological agents that reflects the opinion of the ASAS members, using a Delphi exercise. Further studies are required to assess their relevance and their consistency with clinical practice.

Keywords: ASAS Working Group; ankylosing spondylitis; tumour necrosis factor ; biological agents

Abbreviations: AS, ankylosing spondylitis; ASAS, ASsessment in Ankylosing Spondylitis; BASFI, Bath Ankylosing Spondylitis Functional Index; CRP, C reactive protein; DC-ART, disease controlling antirheumatic treatment; ESR, erythrocyte sedimentation rate; NSAIDs, non-steroidal anti-inflammatory drugs; TNF, tumour necrosis factor ; VAS, visual analogue scale

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International ASAS consensus statement for the use of anti-tumour necrosis factor agents in patients with ankylosing spondylitis

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