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First update of the international ASAS consensus statement for the use of anti-TNF agents in patients with ankylosing spondylitis
  1. J Braun1,
  2. J Davis2,
  3. M Dougados3,
  4. J Sieper4,
  5. S van der Linden5,
  6. D van der Heijde5,
  7. for the ASAS Working Group
  1. 1Rheumazentrum Ruhrgebiet, Herne, and Ruhr University Bochum, Germany
  2. 2Division of Rheumatology, University of California San Francisco, California, USA
  3. 3Department of Rheumatology, Hôpital Cochin, University of Paris, France
  4. 4Medical Department I, Rheumatology, Benjamin Franklin Hospital, Free University Berlin, and German Rheumatism Research Centre Berlin, Germany
  5. 5Department of Internal Medicine, Division of Rheumatology, University of Maastricht, Netherlands
  1. Correspondence to:
    Prof Dr J Braun
    Rheumazentrum Ruhrgebiet, Landgrafenstr 15, 44652 Herne, Germany; J.Braun{at}


Objective: To update the international recommendations for use of anti-tumour necrosis factor (TNF) agents in the treatment of ankylosing spondylitis.

Methods: The published recommendations on anti-TNF treatment in ankylosing spondylitis formed the basis of the update. A questionnaire was sent to the ASAS (assessment in ankylosing spondylitis) members before the final decisions were agreed upon at an international meeting of the ASAS working group.

Results: Only minor changes to the original consensus statement were required. For the initiation of anti-TNF treatment, there should be: a diagnosis of definitive ankylosing spondylitis (normally based on modified New York criteria); active disease for at least four weeks, as defined by a sustained Bath ankylosing spondylitis disease activity index (BASDAI) of ⩾4 on a 0–10 scale and expert opinion based on clinical findings; refractory disease, defined by failure of at least two non-steroidal anti-inflammatory drugs during a three month period, failure of intra-articular steroids (if indicated), and failure of sulfasalazine in patients with predominantly peripheral arthritis; and application of the usual precautions and contraindications for biological treatment. For monitoring anti-TNF treatment: both the ASAS core set for clinical practice and the BASDAI should be followed after the initiation of treatment. Discontinuation of anti-TNF treatment in non-responders should be considered after 6–12 weeks. Response is defined by improvement of at least 50% or 2 units (on a 0–10 scale) of the BASDAI.

Conclusions: This updated consensus statement is recommended in guiding clinical practice and as a basis for developing national guidelines. Evaluation and regular update of this consensus statement is subject to further research by the ASAS group.

  • AGREE, appraisal and guidelines for research and evaluation
  • ASAS, assessment in ankylosing spondylitis
  • BASDAI, Bath ankylosing spondylitis disease activity index
  • BASFI, Bath ankylosing spondylitis functional index
  • DMARD, disease modifying antirheumatic drug
  • NSAID, non-steroidal anti-inflammatory drug
  • QALY, quality adjusted life year
  • TNF, tumour necrosis factor
  • ankylosing spondylitis
  • tumour necrosis factor α
  • infliximab
  • etanercept
  • adalimumab

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  • Published Online First 11 August 2005