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Initiation of biological agents in patients with ankylosing spondylitis: results of a Delphi study by the ASAS Group
  1. T Pham1,
  2. D van der Heijde2,
  3. A Calin3,
  4. M A Khan4,
  5. Sj van der Linden2,
  6. N Bellamy5,
  7. M Dougados6,
  8. for the ASAS Working Group
  1. 1René Descartes University, Cochin Hospital, Paris. Aix-Marseille II University, Conception Hospital, Marseille, France
  2. 2Department of Rheumatology, University Hospital, Maastricht, The Netherlands
  3. 3Royal National Hospital for Rheumatic diseases, Bath, UK
  4. 4Department of Medicine, Case Western Reserve University, MetroHealth Medical Center, Division of Rheumatology, Cleveland, OH, USA
  5. 5Department of Medicine, University of Queensland, Royal Brisbane Hospital, Queensland, Australia
  6. 6Rheumatology B Department, Cochin Hospital, René Descartes University, Paris, France
  1. Correspondence to:
    Professor M Dougados, Rheumatology B Department, Cochin Hospital, 27 rue du Faubourg Saint Jacques, 75014 Paris, France;


Background: There is ample evidence of important symptomatic efficacy of tumour necrosis factor α (TNFα) 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-TNFα 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.

  • ASAS Working Group
  • ankylosing spondylitis
  • tumour necrosis factor α
  • biological agents
  • 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
  • TNFα, tumour necrosis factor α
  • VAS, visual analogue scale

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  • Department and institution to which the work should be attributed: René Descartes University, AP-HP, Rheumatology B Department, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France

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