Article Text

Download PDFPDF
2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis
  1. Désirée van der Heijde1,
  2. Joachim Sieper2,
  3. Walter P Maksymowych3,
  4. Maxime Dougados4,
  5. Rubén Burgos-Vargas5,
  6. Robert Landewé6,7,
  7. Martin Rudwaleit2,
  8. Jürgen Braun8,
  9. for the Assessment of SpondyloArthritis international Society
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Rheumatology, Charité-Benjamin Franklin, Berlin, Germany
  3. 3Department of Rheumatology, University of Alberta, Edmonton, Canada
  4. 4Department of Rheumatology, Cochin Hospital, Paris, France
  5. 5Department of Rheumatology, Hospital General de México and Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
  6. 6Department of Rheumatology, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  7. 7Department of Rheumatology, Atrium Medical Center, Heerlen, The Netherlands
  8. 8Department of Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
  1. Correspondence to Professor Dr D van der Heijde, Department of Rheumatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands; d.vanderheijde{at}


This paper presents the second update of the Assessment in SpondyloArthritis international Society (ASAS) consensus statement on the use of anti-tumour necrosis factor (anti-TNF) agents in patients with axial spondyloarthritis (SpA). A major change from the previous recommendations is that patients fulfilling the ASAS axial SpA criteria, which also include patients fulfilling the modified New York criteria for ankylosing spondylitis, can be treated with anti-TNF agents. This makes an earlier start in the disease process possible. A second major change is the mandatory pretreatment before anti-TNF agents can be started. All patients should have tried a minimum of two non-steroidal anti-inflammatory drugs for a minimum of 4 weeks in total. This is significantly shorter than the previous requirement of 3 months. As previously, patients with axial symptoms require no further pretreatment. Patients with symptomatic peripheral symptoms should normally have had an adequate therapeutic trial of a disease-modifying antirheumatic drug, preferably sulfasalazine. Sulfasalazine is no longer mandatory in this group of patients. Finally, efficacy should be evaluated after at least 12 weeks. The remaining recommendations stayed largely unchanged.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding Wyeth financially supported the mailing of the questionnaire, without influence on the content and without access to the responses of the rheumatologists. All other costs were covered by ASAS.

  • Competing interests DvdH has received honoraria from Abbott, Amgen, AstraZeneca, BMS, Centocor, Chugai, Eli-Lilly, GSK, Merck, Novartis, Otsuka, Pfizer, Roche, Sanofi-Aventis, Schering-Plough, UCB, Wyeth; JS has received honoraria and research support from Abbott, Merck, Centocor, Pfizer, UCB; MD has received consultancy fees and research grants from Pfizer,Abbott, Sanofi-Aventis, BMS, UCB; RB has received honoraria from Abbott, BMS, Merck, Pfizer, Roche; WM Abbott, Centocor, Pfizer, Schering-Plough, Wyeth; RL has received honoraria from Amgen, Abbott, Centocor, Celltech, Glaxo-Smith-Kline, Merck (incl Schering-Plough), Pfizer (incl Wyeth), UCB; MR has received honoraria from Abbott, Centocor, BMS, MSD, Pfizer, Roche, UCB; JB has received honoraria and grants from Abbott, Amgen, BMS, Celgene, Celltrion, Centocor, MSD (Schering-Plough), Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis and UCB.

  • Provenance and peer review Not commissioned; externally peer reviewed.