Recommendation | |
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Patient selection | |
Diagnosis | |
Active disease | |
Treatment failure |
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Assessment of disease | |
ASAS core set for daily practice and BASDAI | |
Assessment of response | |
Responder criteria |
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Time of evaluation |
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↵* Modified New York criteria (van der Linden et al, 1984): Radiological criterion (sacroiliitis, grade ≥II bilaterally or grade III to IV unilaterally) and at least two out of three clinical criteria (low back pain and stiffness for more than 3 months that improves with exercise but is not relieved by rest; limitation of motion of the lumbar spine in both the sagittal and frontal planes; limitation of chest expansion relative to normal values correlated for age and sex).5
↵† See figure 1 for the ASAS axial SpA criteria.6
↵‡ BASDAI assessed on a 0–10 VAS or NRS.14
↵§ The expert is a doctor, usually a rheumatologist, with expertise in inflammatory back pain and the use of biological agents. Experts should be locally defined. An expert opinion should consider clinical features (history and examination) as well as either serum acute phase reactant levels or imaging results, such as radiographs demonstrating rapid progression or MRI scans indicating inflammation.
ASAS core set for daily practice: physical function (BASFI); Pain (VAS/NRS, last week, spine at night, due to AS and VAS/NRS, last week, spine due to AS); spinal mobility (chest expansion, cervical rotation, occiput-to-wall distance, modified Schober, and (lateral lumbar flexion or BASMI); patient's global assessment (VAS/NRS, last week); stiffness (duration of morning stiffness, spine, VAS/NRS, last week); peripheral joints and entheses (number of swollen joints (44 joints count), enthesitis score such as developed in Maastricht, Berlin or San Francisco); acute phase reactants (preferably CRP); fatigue (VAS/NRS).
AS, ankylosing spondylitis; ASAS, Assessment in SpondyloArthritis international Society; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; BASMI, Bath Ankylosing Spondylitis Metrology Index; CRP, C-reactive protein; DMARD, disease-modifying antirheumatic drug; NRS, numerical rating scale; NSAID, non-steroidal anti-inflammatory drug; SpA, spondyloarthritis; TNF, tumour necrosis factor; VAS, visual analogue scale.