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Response to: Correspondence on "ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update" by Braun et al
  1. Sofia Ramiro1,2,
  2. Elena Nikiphorou1,3,4,
  3. Alexandre Sepriano5,
  4. Augusta Ortolan6,7,
  5. Casper Webers8,9,
  6. Xenofon Baraliakos10,
  7. Robert BM Landewé2,11,
  8. Désirée van der Heijde1
  1. 1 Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2 Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
  3. 3 King's College Hospital, London, UK
  4. 4 Centre for Rheumatic Diseases, King's College London, London, UK
  5. 5 Leiden Universitair Medisch Centrum, Leiden, The Netherlands
  6. 6 Department of Medicine DIMED, University of Padova, Rheumatology Unit, Padua, Italy
  7. 7 Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Roma, Italy
  8. 8 Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
  9. 9 Maastricht University, Maastricht, The Netherlands
  10. 10 Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
  11. 11 Rheumatology & Clinical Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Sofia Ramiro, Rheumatology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands; sofiaramiro{at}

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We read with interest the letter by Braun1 pertaining to the 2022 update of the ASAS-EULAR recommendations for the management of axial spondyloarthritis (axSpA).2 Braun questions whether having non-steroidal anti-inflammatory drugs (NSAIDs) as the first mandatory pharmacological treatment is still appropriate. First, doubt is raised whether an insufficient response to NSAIDs, which is required in daily clinical practice and in clinical studies before the start of biological disease-modifying antirheumatic drugs (bDMARDs), is ever formally checked. Whether this is the case or not, we remain firmly of the opinion that this could not, at least without a proof against, be an argument used to delete this from our recommendations. This opinion is based on the well documented and extensive evidence on the efficacy of NSAIDs in axSpA, over long periods of time.

Furthermore, Braun indicates that tumour necrosis factor inhibitors (TNFi) reduce axial inflammation while NSAIDs do not.1 However, it is worth noting that NSAIDs have also shown to decrease axial inflammation to some extent: a decrease in signal intensity of bone marrow oedema of the sacroiliac joints was measured …

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  • Handling editor Josef S Smolen

  • Twitter @sofiaramiro82, @ElenaNikiUK, @AlexSepriano

  • Contributors SR drafted the response. All authors reviewed and approved the final response.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SR received research grants from AbbVie, Galapagos, Novartis, Pfizer and UCB, and consulting fees from AbbVie, Eli Lilly, Novartis, MSD, Pfizer, UCB and Sanofi. EN has received speaker honoraria/participated in advisory boards for Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, Lilly and holds research grants from Pfizer and Lilly. AS has received speaker/consulting fees from Abbvie, Lilly, UCB and Novartis. AO has nothing to declareCasper Webers has nothing to declare. XB, received consulting fees and research grants from Abbvie, BMS, Eli-Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB. XB is an Editorial Board member of Annals of Rheumatic Diseases.Robert Landewé received consulting fees from AbbVie, Bristol Myers Squibb, Celgene, Jansen, Galapagos, Glaxo-Smith-Kline, Novartis, Pfizer, UCB, and is Director of Rheumatology Consultancy BV. DvdH, received consulting fees from AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma and is Director of Imaging Rheumatology bv.

  • Provenance and peer review Commissioned; internally peer reviewed.

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