Comments on recommendations 1–10
| No | Text | Comment |
| 1 | Ligaments/tendons | Attachment of muscle to bone can become inflamed (enthesitis) |
| Other locations | Other areas, such as eyes, lungs, bowel, skin and heart can also become inflamed | |
| Disease activity | Measurement of how affected the patient is. Inflammation is an important part of disease activity | |
| Damage | In ankylosing spondylitis (AS) inflammation, bone destruction and aberrant bone repair coexist with extra bone formation. This causes a condition in the spine by which some or all vertebrae fuse together (ankylosis). Hip joint destruction is primarily characterised by inflammation followed by cartilage loss (coxitis) | |
| 2 | Monitoring | Monitoring is continuous observation and measurement of the patient to check AS continuously. It is more than merely patient follow-up |
| Imaging | Visualisation of body organs using specialised techniques like radiography, ultrasonography or magnetic resonance imaging | |
| Core set | Group of assessments used to quantify the symptoms of patients with AS | |
| ASAS | Assessment of SpondyloArthritis International Society (ASAS) is an international society of experts in the field of spondyloarthritis | |
| 3 | Management | Guidance of the patient including specific treatment options |
| 5 | Anti-inflammatory drugs | Non-steroidal anti-inflammatory drugs (NSAIDs) may have a pain-killing and anti-inflammatory effect. Long-term continuous treatment with NSAIDs may be beneficial in reducing radiographic progression in AS |
| COX-2 inhibitor | Selective cyclo-oxygenase-2 inhibitors are special types of NSAIDs that block the production of prostaglandins. They differ from NSAIDs by targeting only the pain-signalling prostaglandins. COX-2 inhibitors may act without causing stomach problems (eg, ulcers) often associated with other NSAIDs | |
| 6 | Opioids | Opioids (eg, codeine) are powerful pain-killing drugs and these morphine-like drugs may be used to treat chronic pain. Opioid drugs do not cause addiction when used correctly for severe pain under close medical supervision |
| 7 | Steroids | Corticosteroids are a group of anti-inflammatory drugs similar to the hormone cortisol produced in the body. Steroids work by blocking the production of substances in the immune system that trigger inflammatory reactions |
| Site of inflammation | Local inflammation can occur in AS at many different musculoskeletal sites, including spine, joints outside the spine and enthesitis (see comment 1) | |
| 8 | DMARDs | The term disease-modifying antirheumatic drugs (DMARDs) subsumes drugs which suppress the overacting immune system, but the exact mechanism of action is unclear. DMARDs work long term and can take several months to produce results |
| 9 | Anti-TNF | Tumour necrosis factor (TNF) levels are elevated in patients with active AS. Anti-TNF drugs block this molecule and may help reduce inflammation |
| ASAS Recommendation for anti-TNF treatment | ASAS recommendations for the use of anti-TNF drugs in patients with AS are developed for guidance in clinical decision making (see supplementary online data 2) | |
| 10 | Total hip replacement | AS may lead to persistent hip damage requiring replacement with an artificial joint (prosthesis) |
| Severe deformity | In connection with the vertebral fusion of the spine (ankylosis) (see comment 1) the convexity of the thoracic spine can be abnormally increased (kyphosis). This may cause loss of horizontal vision without compensation. In rare cases surgery is used to restore a straighter posture of the spine | |
| Stabilisation | Owing to the extra bone formation in the spine (see comment 1) and possible osteoporosis, the risk of instability and fracture is increased in the spine. In rare cases surgery is used to correct the instability |