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 | |
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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.