Current evidence for the management of ankylosing spondylitis a systematic literature review for the asas/eular management recommendations in ankylosing spondylitis

Jane Zochling ¹, Désirée van der Heijde ², Maxime Dougados ³ and Jürgen Braun ^4*

¹ Rheumazentrum-Ruhrgebiet, Germany
² University Hospital Maastricht, Netherlands
³ Service de Rheumatologie B, Hospital Cochin, France
⁴ Rheumazentrum Ruhrgebiet, Germany

^* To whom correspondence should be addressed. E-mail: j.braun{at}rheumazentrum-ruhrgebiet.de.

Accepted 22 August 2005

Abstract

Objective: To assess available management strategies in ankylosing spondylitis (AS) using a systematic approach, as a part of the development of evidence-based recommendations for the management of AS.

Methods: A systematic search of Medline, Embase, CINAHL, PEDro and the Cochrane Library was performed to identify relevant interventions for the management for ankylosing spondylitis. Evidence for each intervention was categorised by study type, and outcome data for efficacy, adverse effects and cost-effectiveness were abstracted. The effect size (ES), rate ratio (RR), number needed to treat (NNT) and incremental cost- effectiveness ratio (ICER) were calculated for each intervention where possible. Results from randomized controlled trials were pooled where appropriate.

Results: Both pharmacological and non- pharmacological interventions considered to be of interest to clinicians involved in the management of AS were identified. Good evidence (level 1b) exists supporting the use of non-steroidal anti-inflammatory drugs (NSAIDs) and coxibs for symptomatic treatment. Non- pharmacological treatment modalities are also supported for maintaining function in AS. The use of conventional anti-rheumatoid arthritis drugs is not well supported by high level research evidence. Tumour necrosis factor inhibitors (infliximab and etanercept) have level 1b evidence supporting large treatment effects for spinal pain and function in AS over at least 6 months. Level IV evidence supports surgical interventions in specific patients.

Conclusion: This extensive literature review forms the evidence base considered in the development of the new ASAS/EULAR recommendations for the management of AS.

Keywords: ankylosing spondylitis, evidence-based medicine, systematic review

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