ASAS/EULAR recommendations for the management of ankylosing spondylitis

Objective: To develop evidence based recommendations for the
management of ankylosing spondylitis (AS) as a combined effort of
the `ASsessment in AS' international working group and the European
League Against Rheumatism.Methods: Each of the 22 participants was
asked to contribute up to 15 propositions describing key clinical
aspects of AS management. A Delphi process was used to select 10
final propositions. A systematic literature search was then
performed to obtain scientific evidence for each proposition.
Outcome data for efficacy, adverse effects, and cost effectiveness
were abstracted. The effect size, relative risk, number needed to
treat, and incremental cost effectiveness ratio were calculated. On
the basis of the search results, 10 major recommendations for the
management of AS were constructed. The strength of recommendation
was assessed based on the strength of the literature evidence,
risk-benefit trade-off, and clinical expertise.Results: The final
recommendations considered the use of non-steroidal
anti-inflammatory drugs (NSAIDs) (conventional NSAIDs, coxibs, and
co-prescription of gastroprotective agents), disease modifying
antirheumatic drugs, treatments with biological agents, simple
analgesics, local and systemic steroids, non-pharmacological
treatment (including education, exercise, and physiotherapy), and
surgical interventions. Three general recommendations were also
included. Research evidence (categories I--IV) supported 11
interventions in the treatment of AS. Strength of recommendation
varied, depending on the category of evidence and expert
opinion.Conclusion: Ten key recommendations for the treatment of AS
were developed and assessed using a combination of research based
evidence and expert consensus. Regular updating will be carried out
to keep abreast of new developments in the management of AS.