Table 1

Changes between the first and second update of the recommendations for the use of anti-tumour necrosis factor agents in patients with ankylosing spondylitis

Comparison of first and second update of recommendations; changes highlighted in italic bold
2006 Update recommendations2010 Update recommendations
DiagnosisDiagnosis
Patients normally fulfilling modified New York criteria for definitive ankylosing spondylitisPatients fulfilling modified New York criteria for definitive ankylosing spondylitis or the ASAS criteria for axial SpA
Active diseaseActive disease
Active disease for ≥4 weeksActive disease for ≥4 weeks
BASDAI≥4 (0–10) and positive expert opinionBASDAI≥4 (0–10) and positive expert opinion
Treatment failureTreatment failure
All patients: should have had adequate therapeutic trials of at least two NSAIDs; defined as for at least 3 months at maximum recommended dose unless contraindicated; <3 months in cases of intolerance, toxicityAll patients: should have had adequate therapeutic trial of at least two NSAIDs; defined as at least two NSAIDs over a 4-week period in total at maximum recommended dose unless contraindicated;
Axial disease: no pretreatment with DMARDs requiredAxial disease: no pretreatment with DMARDs required
Peripheral arthritis: one local corticosteroid injection if appropriate; therapeutic trial of sulfasalazine (4 months maximum tolerated dose) mandatoryPeripheral arthritis: one local corticosteroid injection if appropriate; should normally have had a therapeutic trial of a DMARD, preferably sulfasalazine
Enthesitis: appropriate local treatmentEnthesitis: appropriate local treatment
ContraindicationsContraindications
List of contraindicationsRefer to annually updated consensus statement on biological agents
Assessment of diseaseAssessment of disease
ASAS core set for daily practice and BASDAIASAS core set for daily practice and BASDAI
Assessment of responseAssessment of response
50% Improvement in BASDAI or absolute change of 2 (0–10) and positive expert opinion in favour of continuation50% Improvement in BASDAI or absolute change of 2 (0–10) and positive expert opinion in favour of continuation
Assessment between 6 and 12 weeksAssessment after at least 12 weeks
  • ASAS, Assessment in SpondyloArthritis international Society; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; DMARD, disease-modifying antirheumatic drug; NSAID, non-steroidal anti-inflammatory drug; SpA, spondyloarthritis.