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 recommendations | 2010 Update recommendations |
| Diagnosis | Diagnosis |
| Patients normally fulfilling modified New York criteria for definitive ankylosing spondylitis | Patients fulfilling modified New York criteria for definitive ankylosing spondylitis or the ASAS criteria for axial SpA |
| Active disease | Active disease |
| Active disease for ≥4 weeks | Active disease for ≥4 weeks |
| BASDAI≥4 (0–10) and positive expert opinion | BASDAI≥4 (0–10) and positive expert opinion |
| Treatment failure | Treatment 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, toxicity | All 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 required | Axial disease: no pretreatment with DMARDs required |
| Peripheral arthritis: one local corticosteroid injection if appropriate; therapeutic trial of sulfasalazine (4 months maximum tolerated dose) mandatory | Peripheral arthritis: one local corticosteroid injection if appropriate; should normally have had a therapeutic trial of a DMARD, preferably sulfasalazine |
| Enthesitis: appropriate local treatment | Enthesitis: appropriate local treatment |
| Contraindications | Contraindications |
| List of contraindications | Refer to annually updated consensus statement on biological agents |
| Assessment of disease | Assessment of disease |
| ASAS core set for daily practice and BASDAI | ASAS core set for daily practice and BASDAI |
| Assessment of response | Assessment of response |
| 50% Improvement in BASDAI or absolute change of 2 (0–10) and positive expert opinion in favour of continuation | 50% Improvement in BASDAI or absolute change of 2 (0–10) and positive expert opinion in favour of continuation |
| Assessment between 6 and 12 weeks | Assessment 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.