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Choufani M, Kay J, Ermann J. Axial spondyloarthritis guidelines - aiming for maximum impact. Curr Opin Rheumatol 2024; 36:251-260. [PMID: 38661436 DOI: 10.1097/bor.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW This review discusses international clinical practice guidelines (CPGs) for axial spondyloarthritis (axSpA) focusing on methodology, guideline quality, and implementation. RECENT FINDINGS The Assessment of SpondyloArthritis International Society/European Alliance of Associations for Rheumatology (ASAS/EULAR) and Pan-American League of Associations for Rheumatology (PANLAR) recently published axSpA CPGs and updates of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network (ACR/SAA/SPARTAN) and Asia-Pacific League of Associations for Rheumatology (APLAR) CPGs are expected. GRADE has emerged as the dominant framework for CPG development and has been used by three of the four international axSpA guidelines. Notable differences exist among these guidelines in the way that the recommendations are presented. Two of the four acknowledge the need for implementation strategies, but little detail about this is provided. The few studies that have evaluated the implementation of axSpA CPGs have identified poor adherence to recommendations on physical therapy/exercise and disease activity monitoring. Implementation science has identified many barriers and facilitators affecting guideline uptake, including those related to healthcare professionals and to the guidelines themselves. Creation of a tailored implementation plan simultaneously with the CPG is recommended. SUMMARY While methodological rigor in the creation of evidence-based recommendations is the focus of CPG development, recommendations must be presented in a user-friendly format that makes them easy to apply. 'Living guidelines' could facilitate keeping content up to date. Implementation is critical for the success of a CPG and should be emphasized in future axSpA guideline updates. Further research is needed to better understand the factors impacting the successful implementation of axSpA CPGs.
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Affiliation(s)
| | - Jonathan Kay
- UMass Chan Medical School and UMass Memorial Medical Center, Worcester
| | - Joerg Ermann
- Brigham and Women's Hospital, Boston
- Harvard Medical School, Boston, Massachusetts, USA
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Aouad K, Wendling D, Breban M, Dadoun S, Hudry C, Moltó A, Pertuiset E, Gossec L. Exploring remission concept in axial spondyloarthritis through the perception of rheumatologists using vignettes and priority ratings. Rheumatology (Oxford) 2021; 61:2603-2608. [PMID: 34528070 DOI: 10.1093/rheumatology/keab711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/01/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The optimal treatment target in axial spondyloarthritis (axSpA) is remission; however, a consensual definition of remission is lacking. Our objective was to explore rheumatologists' perception of remission using vignette cases and a priority exercise. METHODS A cross-sectional survey of rheumatologists' perceptions of remission in axSpA was performed in 2020 using (a) 36 vignette cases, with a single clinical picture and 3 varying parameters (axial pain [ranging from 2 to 5 on a 0-10 scale], fatigue [2-8], and morning stiffness [<15 min, 30 min or 1 h], assessed as remission yes/no; (b) prioritization of elements to consider for remission from a list of 12 items: BASDAI, ASDAS, elements of BASDAI and ASDAS including CRP, NSAIDs use, extra-articular manifestations (EAMs), and other explanations of symptoms e.g. fibromyalgia. Analyses were descriptive. RESULTS Overall, 200 French rheumatologists participated in 2,400 vignette evaluations. Of these, 463 (19%) were classified as remission. The 6 vignette cases representing 56% of all remission cases had <15 min duration of morning stiffness and axial pain ≤3/10, regardless of fatigue levels. Prioritized items for remission were: morning stiffness (75%), EAMs (75%), NSAID use (71%), axial pain (68%), and CRP (66%). CONCLUSIONS When conceptualizing remission in axSpA, rheumatologists took into account morning stiffness and axial pain as expected; the link between remission and fatigue was much weaker. Furthermore, rheumatologists also included EAMs and NSAID use in the concept of remission. Consensus is needed for definition of remission in axSpA.
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Affiliation(s)
- Krystel Aouad
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris
| | - Daniel Wendling
- Rheumatology Department, Besançon University Hospital, Besançon
| | - Maxime Breban
- Service de Rhumatologie, Hôpital Ambroise Paré, AP-HP, Boulogne
- Infection & Inflammation, UMR 1173, Inserm, UVSQ/Université Paris Saclay
- Laboratoire d'Excellence Inflamex, Université de Paris
| | - Sabrina Dadoun
- Rheumatology, Private Practice
- Rheumatology, CeSOA, MGEN Action Sociale
| | | | - Anna Moltó
- Rheumatology Department, Cochin Hospital, APHP
- Rheumatology, INSERM U-1153 (ECAMO), CRESS, Université de Paris, Paris
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris
- Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
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Reyes-Cordero G, Enríquez-Sosa F, Gomez-Ruiz C, Gonzalez-Diaz V, Castillo-Ortiz JD, Duran-Barragán S, Duran-Ortiz JS, Espinosa-Morales R, Gamez-Nava JI, Gonzalez-Lopez L, Julian-Martínez B, Mendoza-Fuentes A, Ramos-Remus C, Pacheco-Tena C, Burgos-Vargas R. Recommendations of the Mexican College of Rheumatology for the Management of Spondyloarthritis. REUMATOLOGIA CLINICA 2021; 17:37-45. [PMID: 31285162 DOI: 10.1016/j.reuma.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/31/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To update the recommendations for the management of patients with Spondyloarthritis (SpA) in the Mexican population, and identify which variables could influence patient management. MATERIAL AND METHODS A group of 15 experts in SpA translated, analyzed and modified the recommendations of the Mexican College of Rheumatology (CMR) and the International Society for the Assessment of Spondyloarthritis (ASAS)/European League Against Rheumatism (EULAR) 2016 group through a systematic review of the literature by two external reviewers during the period from 2015 to 2018 using the grade of recommendation, Oxford levels of evidence, percentage of concordance (Delphi). RESULTS Compared to previous recommendations, there were no significant changes from the year 2015. However, we modified the five fundamental principles and reduced the number of recommendations to ten by incorporating the first item in the text and combining five recommendations into two and adding a further recommendation. We confirmed the tendency to use glucocorticoids for patients with inflammatory activity and scarce access to biologicals. We identified the sociodemographic and clinical characteristics of patients with SpA and their influence on the application of the recommendations. CONCLUSIONS The ten recommendations of the CMR and the analysis of the characteristics of the Mexican patients with SpA focussed on step therapy, including pharmacological and non-pharmacological therapies, in a spectrum from easily accessible to high-tech substances available to a small percentage of the population.
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Affiliation(s)
- Greta Reyes-Cordero
- Hospital Ángeles Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Favio Enríquez-Sosa
- Hospital Regional «General Ignacio Zaragoza», ISSSTE, Ciudad de México, México
| | | | - Verónica Gonzalez-Diaz
- Antiguo Hospital Civil de Guadalajara «Fray Antonio Alcalde», Guadalajara, Jalisco, México
| | | | - Sergio Duran-Barragán
- Clínica de Investigación en Reumatología y Obesidad S.C. Instituto de Investigación en Reumatología y del Sistema Musculoesquelético, Departamento de Clínicas Médicas, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - J Santos Duran-Ortiz
- Servicio de Reumatología, Hospital General de Zona N.(o) 1, Instituto Mexicano del Seguro Social, Tepic, Nayarit, México
| | - Rolando Espinosa-Morales
- Servicio de Reumatología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, México
| | - Jorge I Gamez-Nava
- Unidad de Investigación Biomédica 02, UMAE, Hospital de Especialidades Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, México; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Laura Gonzalez-Lopez
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Bernardo Julian-Martínez
- Servicio de Reumatología, Hospital General de Zona N.(o) 1, Instituto Mexicano del Seguro Social Delegación Hidalgo, Pachuca, Hidalgo, México
| | | | - Cesar Ramos-Remus
- Unidad de Investigación en Enfermedades Crónico-Degenerativas, Guadalajara, Jalisco, México
| | - Cesar Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Ruben Burgos-Vargas
- Hospital General de México «Dr. Eduardo Liceaga», Universidad Nacional Autónoma de México, Ciudad de México, México.
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Baillet A, Romand X, Pflimlin A, Dalecky M, Claudepierrec P, Flipo RM, Ruyssen-Witrand A, Gaudin P, Gossec L, Molto A, Lukas C, Pouplin S, Soubrier M, Wendling D, Fayet F, Hudry C, Senbel E, Schwartz M, Hacquard-Bouder C, Dougados M. Data to be collected for an optimal management of axial spondyloarthritis in daily practice: Proposal from evidence-based and consensual approaches. Joint Bone Spine 2020; 87:405-411. [PMID: 32428691 DOI: 10.1016/j.jbspin.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/30/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To propose a list of variables to be collected right after the diagnosis has been made and during the follow-up of patients with axial spondyloarthritis (ax-SpA) for an optimal management in daily practice. METHODS The process comprised (1) the evaluation of the interest of 51 variables proposed for the assessment of ax-SpA by means of a systematic literature research; (2) a consensus process involving 78 hospital-based or office-based rheumatologists, considering the collection of each variable in a 4 grade scale from "not very useful/useless" to "mandatory"; (3) a consensus on the minimum interval of time for periodic assessment of the selected variables on a 5 grade scale from "at each visit" to "never to be re-collected". RESULTS The systematic literature research retrieved a total of 14,133 abstracts, of which 213 were included in the final qualitative synthesis. Data to be collected at the initial systematic review comprised 5 patient's self-administered questionnaires, 3 variables of the physician's interview, 2 variables of the physical examination, 2 variables of the specific ax-SpA imaging and 2 other investigations. Two variables were recommended to be systematically collected at each visit, 1 variable twice a year, 6 variables yearly and 1 variable every 2 years. CONCLUSIONS Using an evidence-based and an expert consensus approaches, this initiative defined a core set of variables to be collected and reported right after the diagnosis and during follow-up of patients with ax-SpA in daily practice.
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Affiliation(s)
- Athan Baillet
- University Grenoble Alpes, GREPI TIMC, CNRS UMR 5525, Grenoble, France.
| | - Xavier Romand
- University Grenoble Alpes, GREPI TIMC, CNRS UMR 5525, Grenoble, France
| | - Arnaud Pflimlin
- Rheumatology, R Salengro Hospital, University of Lille, Lille, France
| | - Mickael Dalecky
- University Grenoble Alpes, GREPI TIMC, CNRS UMR 5525, Grenoble, France
| | - Pascal Claudepierrec
- Departement de Rhumatologie, Henri Mondor Hospital, AP-HP, Université Paris Est Créteil, EA 7379 - EpidermE, 94010, Créteil, France
| | - René-Marc Flipo
- Rheumatology, R Salengro Hospital, University of Lille, Lille, France
| | - Adeline Ruyssen-Witrand
- Rheumatology, UMR 1027 Inserm, Paul Sabatier University and Purpan Hospital, Toulouse, France. Sorbonne Universités, UPMC Univ, Paris, France
| | - Philippe Gaudin
- University Grenoble Alpes, GREPI TIMC, CNRS UMR 5525, Grenoble, France
| | - Laure Gossec
- Sorbonne Université, inserm, Institut Pierre-Louis d'épidémiologie et de santé Publique, Paris, France; Pitié Salpêtrière hospital, AP-HP, Rheumatology department, Paris, France
| | - Anna Molto
- Paris Descartes University, Department of Rheumatology - Hôpital Cochin. Assistance publique-Hôpitaux de Paris. inserm (U1153): Clinical epidemiology and biostatistics, Université de Paris, Paris, France
| | - Cédric Lukas
- Department of Rheumatology, CHU Montpellier and UMR5535 CNRS, Montpellier, France
| | | | - Martin Soubrier
- Department of Rheumatology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Daniel Wendling
- Department of Rheumatology, CHRU Besançon, and EA 4266, Université de Franche-Comté, Besançon, France
| | - Françoise Fayet
- Department of Rheumatology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Christophe Hudry
- Department of Rheumatology - Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Senbel
- AP-HM, Rheumatology Department, Sainte Marguerite Hospital, Marseille, France
| | - Marjorie Schwartz
- Departement de Rhumatologie, Henri Mondor Hospital, AP-HP, Université Paris Est Créteil, EA 7379 - EpidermE, 94010, Créteil, France
| | | | - Maxime Dougados
- Paris Descartes University, Department of Rheumatology - Hôpital Cochin. Assistance publique-Hôpitaux de Paris. inserm (U1153): Clinical epidemiology and biostatistics, Université de Paris, Paris, France
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Pereira-Gillion C, Marot M, Griffoul-Espitalier I, Andras L, Goupille P, Salliot C. Application of Recommendations Regarding the Use of Subcutaneous Tumor Necrosis Factor Inhibitors in Spondyloarthritis by Rheumatologists in Daily Practice. J Rheumatol 2018; 45:491-497. [PMID: 29419472 DOI: 10.3899/jrheum.170587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the implementation of European recommendations for use of TNF inhibitors for spondyloarthritis (SpA), rheumatologists' level of knowledge of and adherence to the recommendations, and potential barriers to the application of recommendations. METHODS We conducted a retrospective study among 42 rheumatologists who initiated a first subcutaneous TNF inhibitor for SpA in 2013 or 2014. Thirty items from national and international recommendations were separated into 3 domains: indication, pretherapeutic monitoring, and management under TNF inhibitors. A standardized data collection procedure was used to gather data from medical files to assess the application of each recommendation. Questionnaires assessing the knowledge, level of adherence to each recommendation, and potential barriers to their implementation were sent to rheumatologists. RESULTS Rheumatologists applied a mean of 60% of items from domains A and B, but less than 50% from domain C items. Recommendations regarding the search for previous infection and the prevention of future infections were the ones most often applied. However, < 60% of rheumatologists assessed cancer and other diseases before TNF inhibitor initiation. More than 95% of rheumatologists knew of the recommendations and had a high level of adherence. Lack of time, difficulties accessing specialized consultations, and lack of flexibility in the recommendations explained rheumatologists' difficulties in applying the recommendations. CONCLUSION Despite high levels of knowledge of, and adherence to, recommendations for using TNF inhibitors for SpA, rheumatologists' application was limited because of a lack of human and material resources.
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Affiliation(s)
- Céline Pereira-Gillion
- From the Centre Hospitalier Regional Universitaire (CHRU) de Tours; Université François Rabelais de Tours, Rheumatology Unit, Tours; Centre Hospitalier de Blois, Rheumatology Unit, Blois; Centre Hospitalier Regional d'Orleans, Rheumatology Unit; Université d'Orléans, I3MTO Laboratory EA 4708, Orleans, France.,C. Pereira-Gillion, MD, CHRU de Tours; M. Marot, MD, CHRU de Tours; I. Griffoul-Espitalier, MD, CHRU de Tours; L. Andras, MD, Centre Hospitalier de Blois, Rheumatology Unit; P. Goupille, Professor, CHRU de Tours, and Université François Rabelais de Tours, UMR CNRS 7292, CHRU de Tours; C. Salliot, MD, Centre Hospitalier Regional d'Orleans, Rheumatology Unit, and Université d'Orléans, I3MTO Laboratory EA 4708
| | - Mathilde Marot
- From the Centre Hospitalier Regional Universitaire (CHRU) de Tours; Université François Rabelais de Tours, Rheumatology Unit, Tours; Centre Hospitalier de Blois, Rheumatology Unit, Blois; Centre Hospitalier Regional d'Orleans, Rheumatology Unit; Université d'Orléans, I3MTO Laboratory EA 4708, Orleans, France.,C. Pereira-Gillion, MD, CHRU de Tours; M. Marot, MD, CHRU de Tours; I. Griffoul-Espitalier, MD, CHRU de Tours; L. Andras, MD, Centre Hospitalier de Blois, Rheumatology Unit; P. Goupille, Professor, CHRU de Tours, and Université François Rabelais de Tours, UMR CNRS 7292, CHRU de Tours; C. Salliot, MD, Centre Hospitalier Regional d'Orleans, Rheumatology Unit, and Université d'Orléans, I3MTO Laboratory EA 4708
| | - Isabelle Griffoul-Espitalier
- From the Centre Hospitalier Regional Universitaire (CHRU) de Tours; Université François Rabelais de Tours, Rheumatology Unit, Tours; Centre Hospitalier de Blois, Rheumatology Unit, Blois; Centre Hospitalier Regional d'Orleans, Rheumatology Unit; Université d'Orléans, I3MTO Laboratory EA 4708, Orleans, France.,C. Pereira-Gillion, MD, CHRU de Tours; M. Marot, MD, CHRU de Tours; I. Griffoul-Espitalier, MD, CHRU de Tours; L. Andras, MD, Centre Hospitalier de Blois, Rheumatology Unit; P. Goupille, Professor, CHRU de Tours, and Université François Rabelais de Tours, UMR CNRS 7292, CHRU de Tours; C. Salliot, MD, Centre Hospitalier Regional d'Orleans, Rheumatology Unit, and Université d'Orléans, I3MTO Laboratory EA 4708
| | - Lucia Andras
- From the Centre Hospitalier Regional Universitaire (CHRU) de Tours; Université François Rabelais de Tours, Rheumatology Unit, Tours; Centre Hospitalier de Blois, Rheumatology Unit, Blois; Centre Hospitalier Regional d'Orleans, Rheumatology Unit; Université d'Orléans, I3MTO Laboratory EA 4708, Orleans, France.,C. Pereira-Gillion, MD, CHRU de Tours; M. Marot, MD, CHRU de Tours; I. Griffoul-Espitalier, MD, CHRU de Tours; L. Andras, MD, Centre Hospitalier de Blois, Rheumatology Unit; P. Goupille, Professor, CHRU de Tours, and Université François Rabelais de Tours, UMR CNRS 7292, CHRU de Tours; C. Salliot, MD, Centre Hospitalier Regional d'Orleans, Rheumatology Unit, and Université d'Orléans, I3MTO Laboratory EA 4708
| | - Philippe Goupille
- From the Centre Hospitalier Regional Universitaire (CHRU) de Tours; Université François Rabelais de Tours, Rheumatology Unit, Tours; Centre Hospitalier de Blois, Rheumatology Unit, Blois; Centre Hospitalier Regional d'Orleans, Rheumatology Unit; Université d'Orléans, I3MTO Laboratory EA 4708, Orleans, France.,C. Pereira-Gillion, MD, CHRU de Tours; M. Marot, MD, CHRU de Tours; I. Griffoul-Espitalier, MD, CHRU de Tours; L. Andras, MD, Centre Hospitalier de Blois, Rheumatology Unit; P. Goupille, Professor, CHRU de Tours, and Université François Rabelais de Tours, UMR CNRS 7292, CHRU de Tours; C. Salliot, MD, Centre Hospitalier Regional d'Orleans, Rheumatology Unit, and Université d'Orléans, I3MTO Laboratory EA 4708
| | - Carine Salliot
- From the Centre Hospitalier Regional Universitaire (CHRU) de Tours; Université François Rabelais de Tours, Rheumatology Unit, Tours; Centre Hospitalier de Blois, Rheumatology Unit, Blois; Centre Hospitalier Regional d'Orleans, Rheumatology Unit; Université d'Orléans, I3MTO Laboratory EA 4708, Orleans, France. .,C. Pereira-Gillion, MD, CHRU de Tours; M. Marot, MD, CHRU de Tours; I. Griffoul-Espitalier, MD, CHRU de Tours; L. Andras, MD, Centre Hospitalier de Blois, Rheumatology Unit; P. Goupille, Professor, CHRU de Tours, and Université François Rabelais de Tours, UMR CNRS 7292, CHRU de Tours; C. Salliot, MD, Centre Hospitalier Regional d'Orleans, Rheumatology Unit, and Université d'Orléans, I3MTO Laboratory EA 4708.
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Braun J, Kiltz U, Sarholz M, Heldmann F, Regel A, Baraliakos X. Monitoring ankylosing spondylitis: clinically useful markers and prediction of clinical outcomes. Expert Rev Clin Immunol 2015; 11:935-46. [PMID: 26048334 DOI: 10.1586/1744666x.2015.1052795] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patient assessment in axial spondyloarthritis (axSpA) is multidimensional, and monitoring of disease activity, function and radiographic progression is complex. There is no simple 'gold standard' for measuring disease activity in all individual patients, as disease activity in axSpA is the sum of many different aspects and a complexity that cannot be represented by a single variable. Limited spinal mobility is a cardinal sign of ankylosing spondylitis and loss of spinal mobility has been reported to be a prognostic factor and most often evaluated with the Bath Ankylosing Spondylitis Functional Index. Imaging of the spine and assessment of safety aspects plays an important role in the monitoring of patients with axSpA. The timeframe for collecting information regarding disease activity, function and radiographic progression are recommended on an individual basis.
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Affiliation(s)
- Juergen Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr 45, 44649 Herne Germany
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Ciurea A, Weber U, Stekhoven D, Scherer A, Tamborrini G, Bernhard J, Toniolo M, Villiger PM, Zufferey P, Kissling RO, Michel BA, Exer P. Treatment with Tumor Necrosis Factor Inhibitors in Axial Spondyloarthritis: Comparison Between Private Rheumatology Practices and Academic Centers in a Large Observational Cohort. J Rheumatol 2014; 42:101-5. [DOI: 10.3899/jrheum.140229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate the initiation of and response to tumor necrosis factor (TNF) inhibitors for axial spondyloarthritis (axSpA) in private rheumatology practices versus academic centers.Methods.We compared newly initiated TNF inhibition for axSpA in 363 patients enrolled in private practices with 100 patients recruited in 6 university hospitals within the Swiss Clinical Quality Management (SCQM) cohort.Results.All patients had been treated with ≥ 1 nonsteroidal antiinflammatory drug and > 70% of patients had a baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4 before anti-TNF agent initiation. The proportion of patients with nonradiographic axSpA (nr-axSpA) treated with TNF inhibitors was higher in hospitals versus private practices (30.4% vs 18.7%, p = 0.02). The burden of disease as assessed by patient-reported outcomes at baseline was slightly higher in the hospital setting. Mean levels (± SD) of the Ankylosing Spondylitis Disease Activity Score were, however, virtually identical in private practices and academic centers (3.4 ± 1.0 vs 3.4 ± 0.9, p = 0.68). An Assessment of SpondyloArthritis international Society (ASAS40) response at 1 year was reached for ankylosing spondylitis in 51.7% in private practices and 52.9% in university hospitals (p = 1.0) and for nr-axSpA in 27.5% versus 25.0%, respectively (p = 1.0).Conclusion.With the exception of a lower proportion of patients with nr-axSpA newly treated with anti-TNF agents in private practices in comparison to academic centers, adherence to ASAS treatment recommendations for TNF inhibition was equally high, and similar response rates to TNF blockers were achieved in both clinical settings.
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Kiltz U, Sieper J, Braun J. [ASAS recommendations on the use of TNF inhibitors for patients with axial spondyloarthritis : evaluation of the 2010 update in the German-speaking area]. Z Rheumatol 2013; 72:81-8. [PMID: 23338704 DOI: 10.1007/s00393-012-1089-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The ASAS recommendations on the use of tumor necrosis factor (TNF) inhibitors for patients with axial spondyloarthritis were amended in 2010. Essential new aspects have been included in the update. The diagnosis is extended from patients with ankylosing spondlitis (AS) to all patient groups of axial spondyloarthritis. Pretreatment with at least two non-steroidal anti-rheumatic drugs (NSARD) for 4 weeks is recommended. The success of therapy with TNF inhibitors is to be compiled after at least 12 weeks.This article presents the results of the evaluation of the German translation of these recommendations. A total of 25 experts from Germany, Austria and Switzerland have scored the translation on a scale between 0 (no agreement) and 10 (full agreement) with respect to the recommendation grade. The agreement on the recommendations between the experts was very high (8.98 ± 1.25).
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Landgrafenstr. 15, 44652, Herne.
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Poddubnyy D, van der Heijde D. Therapeutic controversies in spondyloarthritis: nonsteroidal anti-inflammatory drugs. Rheum Dis Clin North Am 2012; 38:601-11. [PMID: 23083758 DOI: 10.1016/j.rdc.2012.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered a first-line therapy in patients with axial spondyloarthritis (axSpA), including ankylosing spondylitis. NSAIDs reduce pain and stiffness effectively in most patients, are able to reduce systemic and local inflammation, and can inhibit progression of structural damage in the spine. However, effective control of symptoms and retardation of radiographic progression often require continuous and long-term treatment, which raises safety concerns. This article discusses controversies related to the current role of NSAIDs in axSpA treatment, risks and benefits of this treatment, and current trends for individualized treatment.
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Affiliation(s)
- Denis Poddubnyy
- Rheumatology, Medical Department I, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin 12203, Germany.
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Critical Appraisal of the Guidelines for the Management of Ankylosing Spondylitis: Disease-Modifying Antirheumatic Drugs. Am J Med Sci 2012; 343:357-9. [PMID: 22543537 DOI: 10.1097/maj.0b013e3182513f9c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Consensus Statement of the Spanish Society of Rheumatology on Risk Management of Biologic Therapy in Rheumatic Patients. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.reumae.2011.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Reino JG, Loza E, Andreu JL, Balsa A, Batlle E, Cañete JD, Collantes Estévez E, Fernández Carballido C, Fernández Sueiro JL, García de Vicuña R, González-Álvaro I, González Fernández C, Juanola X, Linares LF, Marenco JL, Martín Mola E, Moreno Ramos M, Mulero Mendoza J, Muñoz Fernández S, Queiro R, Richi Alberti P, Sanz J, Tornero Molina J, Zarco Montejo P, Carmona L. Consenso SER sobre la gestión de riesgo del tratamiento con terapias biológicas en pacientes con enfermedades reumáticas. ACTA ACUST UNITED AC 2011; 7:284-98. [DOI: 10.1016/j.reuma.2011.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/04/2011] [Accepted: 05/04/2011] [Indexed: 12/16/2022]
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Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, Dagfinrud H, Dijkmans B, Dougados M, Emery P, Geher P, Hammoudeh M, Inman RD, Jongkees M, Khan MA, Kiltz U, Kvien T, Leirisalo-Repo M, Maksymowych WP, Olivieri I, Pavelka K, Sieper J, Stanislawska-Biernat E, Wendling D, Ozgocmen S, van Drogen C, van Royen B, van der Heijde D. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011; 70:896-904. [PMID: 21540199 PMCID: PMC3086052 DOI: 10.1136/ard.2011.151027] [Citation(s) in RCA: 607] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This first update of the ASAS/EULAR recommendations on the management of ankylosing spondylitis (AS) is based on the original paper, a systematic review of existing recommendations and the literature since 2005 and the discussion and agreement among 21 international experts, 2 patients and 2 physiotherapists in a meeting in February 2010. Each original bullet point was discussed in detail and reworded if necessary. Decisions on new recommendations were made — if necessary after voting. The strength of the recommendations (SOR) was scored on an 11-point numerical rating scale after the meeting by email. These recommendations apply to patients of all ages that fulfill the modified NY criteria for AS, independent of extra-articular manifestations, and they take into account all drug and non-drug interventions related to AS. Four overarching principles were introduced, implying that one bullet has been moved to this section. There are now 11 bullet points including 2 new ones, one related to extra-articular manifestations and one to changes in the disease course. With a mean score of 9.1 (range 8-10) the SOR was generally very good.
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Affiliation(s)
- J Braun
- Rheumazentrum Ruhrgebiet, Landgrafenstrasse 15, 44652 Herne, Germany.
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Vastesaeger N, van der Heijde D, Inman RD, Wang Y, Deodhar A, Hsu B, Rahman MU, Dijkmans B, Geusens P, Vander Cruyssen B, Collantes E, Sieper J, Braun J. Predicting the outcome of ankylosing spondylitis therapy. Ann Rheum Dis 2011; 70:973-81. [PMID: 21402563 PMCID: PMC3086037 DOI: 10.1136/ard.2010.147744] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives To create a model that provides a potential basis for candidate selection for anti-tumour necrosis factor (TNF) treatment by predicting future outcomes relative to the current disease profile of individual patients with ankylosing spondylitis (AS). Methods ASSERT and GO–RAISE trial data (n=635) were analysed to identify baseline predictors for various disease-state and disease-activity outcome instruments in AS. Univariate, multivariate, receiver operator characteristic and correlation analyses were performed to select final predictors. Their associations with outcomes were explored. Matrix and algorithm-based prediction models were created using logistic and linear regression, and their accuracies were compared. Numbers needed to treat were calculated to compare the effect size of anti-TNF therapy between the AS matrix subpopulations. Data from registry populations were applied to study how a daily practice AS population is distributed over the prediction model. Results Age, Bath ankylosing spondylitis functional index (BASFI) score, enthesitis, therapy, C-reactive protein (CRP) and HLA-B27 genotype were identified as predictors. Their associations with each outcome instrument varied. However, the combination of these factors enabled adequate prediction of each outcome studied. The matrix model predicted outcomes as well as algorithm-based models and enabled direct comparison of the effect size of anti-TNF treatment outcome in various subpopulations. The trial populations reflected the daily practice AS population. Conclusion Age, BASFI, enthesitis, therapy, CRP and HLA-B27 were associated with outcomes in AS. Their combined use enables adequate prediction of outcome resulting from anti-TNF and conventional therapy in various AS subpopulations. This may help guide clinicians in making treatment decisions in daily practice.
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Kiltz U, Feldtkeller E, Braun J. [German patient version of the ASAS/EULAR recommendations for the management of ankylosing spondylitis]. Z Rheumatol 2010; 69:171-4, 176-9. [PMID: 19214540 DOI: 10.1007/s00393-009-0428-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The evidence-based recommendations on the management of ankylosing spondylitis (AS) have enjoyed a high level of acceptance and circulation in Germany, as well as in other European countries. To make patient participation in the decision-making process regarding their disease easier, as well as to strengthen the physician-patient relationship, the ASAS and EULAR have set up an initiative to formulate a patient-friendly version of the recommendations, initially in English. In order that this lay version can also be used in German-speaking countries, a group predominantly comprising patients was formed to ensure that the German translation of this version has the broadest possible basis. In cooperation with the German (DVMB), Austrian (OVMB) and Swiss Morbus Bechterew Associations (SVMB), as well as the German Rheumatology League, patients from Germany, Austria and Switzerland with appropriate English skills were invited to a meeting in 2008. The aim of the translation was to leave the content unchanged while finding a level of speech easily understandable to the lay person. The translated text was considered as accepted when a minimum of 12 patients (>80%) gave their approval on the wording of the translation of individual recommendations in an open vote. The rheumatologist given the function of moderator was not entitled to vote. The level of approval for each recommendation was determined (0: no approval to 10: full approval). The 14 patients were able to translate the English patient version into German. Choice of words and style of speech were discussed intensively. Acceptance of the translation of the 10 recommendations was generally high. The content was clearly accepted with an approval rate of 8.4+/-1.6. This was the first time that patients, in cooperation with rheumatologists, have translated an international patient version on AS management into German under controlled conditions. The translation text was approved by the majority in terms of both form and content. Acceptance and circulation of the German patient version should be evaluated in the near future.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne, Deutschland.
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Braun J, Sieper J. [Dissemination and evaluation of ASAS/EULAR recommendations for the management of ankylosing spondylitis in Europe]. Z Rheumatol 2009; 68:417-9. [PMID: 19449018 DOI: 10.1007/s00393-009-0464-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J Braun
- Rheumazentrum Ruhrgebiet, Herne.
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[Patient evaluation of the German version of the ASAS/EULAR recommendations for the management of ankylosing spondylitis]. Z Rheumatol 2009; 67:694-700, 702. [PMID: 19011877 DOI: 10.1007/s00393-008-0371-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
On the initiative of the ASAS (Assessment of SpondyloArthritis International Society) and EULAR (European League against Rheumatism), evidence-based recommendations for the management of ankylosing spondylitis (AS) were drawn up, with healthcare professionals as the target group for these recommendations. To facilitate patient participation in the decision-making process with regard to their disease, and to further improve the doctor-patient relationship, the ASAS and EULAR are working on a patient-friendly version of the recommendations.In order to establish to what extent the ASAS/EULAR recommendations, as translated by German experts, can be understood by patients, the recommendations for health care professionals, together with an evaluation form, was distributed to 105 delegates of the German society for ankylosing spondylitis (Deutschen Vereinigung Morbus Bechterew, DVMB). Responders were questioned on text comprehension and their level of agreement (0: not agree at all to 10: fully agree). Space was also provided for additional comments.In total, 59 delegates filled out the questionnaire (rate of return: 56.2%). For recommendation Nos. 1, 2, 5, 6 and 7, text comprehension was moderate. On average, the recommendations were positively assessed with 8.38+/-1.9. Recommendation No. 4 (non-pharmacological therapy) was given the highest agreement (9.54+/-1.02), while recommendation No. 7 (corticosteroids, 6.54+/-2.55) received the lowest agreement. The acceptance of the recommendation was high with 87.9% questions answered.For the first time, the German expert translation of recommendations for the management of AS patients was evaluated by patients. The present translation met with broad approval. To minimize text comprehension problems, patients should be involved in compiling a future patient version.
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