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Empfehlungen für das Management der ankylosierenden Spondylitis gemäß ASAS/EULAR

Evaluation im deutschsprachigen Raum

Recommendations for the management of ankylosing spodylitis after ASAS/EULAR: evaluation in the German language area

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Zusammenfassung

Ziel: Adaptierung und Implementierung der von der „ASsessments in AS (ASAS) International Working Group“ zusammen mit der „European League against Rheumatism“ (EULAR, die europäische Rheumatologenvereinigung) entwickelten evidenzbasierten Empfehlungen für das Management der ankylosierenden Spondylitis (AS) im Rahmen des Kompetenznetzwerks (KNW) Rheumatologie im deutschsprachigen Raum.

Methoden: In dem ASAS/EULAR-Projekt wurden die Wirkstärke („effect size“, ES), die „rate ratio“ (RR), die Anzahl der zu behandelnden Patienten („number needed to treat“, NNT) und die „incremental cost-effectiveness ratio“ (ICER, das Verhältnis der Änderung der Kosten zur Änderung der Wirksamkeit) berechnet. Die Stärke der Empfehlungen wurde durch die Evidenzlevel der Literatursuche, durch den „risk-benefit trade-off“ (die Risiko-Nutzen-Bewertung) und die klinische Erfahrung der Experten ermittelt. Die Empfehlungen wurden kürzlich in englischer Sprache publiziert.

Alle am Schwerpunkt Spondyloarthritis (SpA) des KNW beteiligten Zentren und 35 weitere Experten erhielten das englische Manuskript zugesandt. Alle 35 Teilnehmer wurden aufgefordert, die 10 Hauptempfehlungen für das Management von AS quantitativ (Übereinstimmung 0–10-Skala) zu bewerten.

Ergebnisse: Die Empfehlungen umfassen den Einsatz von Medikamenten wie nichtsteroidale Antiphlogistika (NSAR), was neben konventionellen NSAR auch Coxibe und den parallelen Einsatz von Gastroprotektiva, so genannte krankheitsmodulierende Präparate „disease-modifying anti-rheumatic drugs“, DMARDs), Biologika, einfache Analgetika, lokal und systemische Glukokortikoide, nichtpharmakologische Therapien (wie Patientenschulung, medizinische Trainingstherapie und Physiotherapie) sowie chirurgische Behandlungsmaßnahmen einschließt. Darüber hinaus wurden 3 generelle Empfehlungen ausgesprochen und ein Behandlungsschema unter Berücksichtigung der verschiedenen klinischen Manifestationen erstellt. Die Stärke der ASAS/EULAR-Empfehlungen war insgesamt ausgeprägt. Die Übereinstimmung der deutschsprachigen Experten mit dem internationalen Vorschlag fiel sehr deutlich aus: im Mittel 9,13, mit relativ geringer Variabilität zwischen den Empfehlungen.

Zusammenfassung: Zehn Schlüsselempfehlungen für die Behandlung der AS wurden entwickelt, die durch systematische Literaturrecherche gestützt und durch Expertenkonsensus bekräftigt wurden. Eine große Gruppe deutschsprachiger Experten stimmt mit dem Vorschlag weitgehend überein. Dies kann als Ausgangspunkt für eine weitere Disseminierung und Implementierung dienen.

Abstract

Aim: Our aim was to adapt and implement the evidence based recommendations for the management of ankylosing spodylitis (AS) of the “Assessments in AS” (ASAS) International Working Group together with the European League Against Rheumatism (EULAR) within the framework of a competence network (CN) in rheumatology in the German language area.

Methods: The ASAS/EULAR project calculated the effective size (ES), rate ratio, number of patients requiring treatment (number needed to treat, NNT) and the incremental cost-effectiveness ratio (ICER). The strength of the recommendations was determined through the evidence level found in the literature, the risk-benefit trade-off and the clinical experience of the experts. The recommendations were recently published in English.

All of the centers taking part in the study area Spondyloarthritis (SpA) CN, as well as an additional 35 experts, were sent the English manuscript. All 35 participants were asked to evaluate the ten main management recommendations on a scale from 0 to 10.

Results: The recommendations encompass the use of drugs such as non-steroid anti-inflammatories (NSAR), which, along with conventional NSAR include coxibs and the parallel application of gastroprotectives, so called disease-modifying anti-rheumatic drugs, biologicals, simple analgesics, local and systematic glucocorticoids, non-drug therapies (such as patient training, medical training therapy and physiotherapy), in addition to surgical treatment methods. Moreover, three general recommendations were formulated and a therapy scheme created, taking into consideration the various clinical manifestations. The strength of the ASAS/EULAR recommendations was generally high. There was a marked consensus between the German speaking experts and the international proposal: a mean of 9.13 with relatively low variation between the recommendations.

Summary: Ten key recommendations for the treatment of AS were developed. These were strengthened by a systematic search of the literature and by expert consensus. The large group of German speaking experts were largely in agreement with the proposal. This can be seen as a starting point for the dissemination and implementation of the recommendations.

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Abb. 1

Notes

  1. Thematisch geordnet (generell, nichtpharmakologisch, pharmakologisch, invasiv und chirurgisch)

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Danksagung

Wir bedanken uns bei den folgenden deutschsprachigen Experten für Ihre Bewertung und die konstruktiven Kommentare:

PD Dr. Brandt, Berlin; Dr. Droste, Bad Kreuznach; Dr.Edelmann, Bad Aibling; Dr. Ehlebracht-König, Bad Eilsen; Dr. Engel, Bad Liebenwerda; Prof. Falkenbach, Bad Ischl; Prof. Genth, Aachen; Prof. Grifka, Bad Abbach; Prof. Hammer, Sendenhorst; Dr. Hermann, Graz/Österreich; Dr. Karberg, Berlin; Prof. Kellner, München; Dr. Krause, Gladbeck; Prof. Krüger, München; Prof. Kuipers, Bremen; Prof. Lakomek, Minden; PD Dr. Langer, Düsseldorf; Prof. Manger, Erlangen; Prof. Märker-Hermann, Wiesbaden; Prof. Mau, Halle; Prof. Michel, Zürich/Schweiz; Dr. Miehle, Bad Aibling; Prof. Oestensen, Bern/Schweiz; Prof. Rau, Ratingen; PD Dr. Rehart, Frankfurt; PD Dr. Rudwaleit, Berlin; Prof. Schattenkirchner, München; Prof. Smolen, Wien/Österreich; Prof. Wagner, Nienburg; Dr. Weber, Zürich/Schweiz; Prof. Wollenhaupt, Hamburg; Prof. Zacher, Berlin; Prof. Zeidler, Hannover.

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Authors and Affiliations

  1. Klinik Innere Medizin IV, Dr. Horst-Schmidt-Kliniken GmbH, Wiesbaden, Deutschland

    E. Märker-Hermann

  2. Abteilung für Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität München, Deutschland

    G. Stucki

  3. Radiologische Universitätsklinik der Rheinischen Friedrich-Wilhelms Universität Bonn, Deutschland

    H. Böhm

  4. Abteilung Rheumatologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland

    M. Rudwaleit

  5. Abteilung für Rheumatologie, Medizinische Hochschule Hannover, Deutschland

    H. Zeidler

  6. Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Deutschland

    J. Sieper

  7. Rheumazentrum-Ruhrgebiet, St. Josefs-Krankenhaus, Landgrafenstraße 15, 44652, Herne, Deutschland

    J. Braun & J. Zochling

Authors
  1. J. Braun
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  2. J. Zochling
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  3. E. Märker-Hermann
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  4. G. Stucki
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  8. J. Sieper
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Correspondence to J. Braun.

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Braun, J., Zochling, J., Märker-Hermann, E. et al. Empfehlungen für das Management der ankylosierenden Spondylitis gemäß ASAS/EULAR. Z. Rheumatol. 65, 728–742 (2006). https://doi.org/10.1007/s00393-006-0119-3

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