Table 2

Comments on recommendations 1–10

NoTextComment
1Ligaments/tendonsAttachment of muscle to bone can become inflamed (enthesitis)
Other locationsOther areas, such as eyes, lungs, bowel, skin and heart can also become inflamed
Disease activityMeasurement of how affected the patient is. Inflammation is an important part of disease activity
DamageIn 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)
2MonitoringMonitoring is continuous observation and measurement of the patient to check AS continuously. It is more than merely patient follow-up
ImagingVisualisation of body organs using specialised techniques like radiography, ultrasonography or magnetic resonance imaging
Core setGroup of assessments used to quantify the symptoms of patients with AS
ASASAssessment of SpondyloArthritis International Society (ASAS) is an international society of experts in the field of spondyloarthritis
3ManagementGuidance of the patient including specific treatment options
5Anti-inflammatory drugsNon-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 inhibitorSelective 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
6OpioidsOpioids (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
7SteroidsCorticosteroids 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 inflammationLocal inflammation can occur in AS at many different musculoskeletal sites, including spine, joints outside the spine and enthesitis (see comment 1)
8DMARDsThe 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
9Anti-TNFTumour 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 treatmentASAS 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)
10Total hip replacementAS may lead to persistent hip damage requiring replacement with an artificial joint (prosthesis)
Severe deformityIn 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
StabilisationOwing 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