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• W2807180238 abstract "Advances in the Management of Ankylosing Spondylitis Treatment algorithm and prognosisRubén Burgos-VargasRubén Burgos-VargasRubén Burgos-Vargas graduated from the Faculty of Medicine at the Universidad Nacional Autonoma de México (Mexico City, Mexico) in 1977. He is certified by the Consejo Mexicano de Reumatologia as a Rheumatologist and Pediatric Rheumatologist. He trained with Barbara Ansell in the UK in 1982–1983. His main interest has been juvenile- and adult-onset spondyloarthritis. He has authored and coauthored many papers and book chapters. He has participated in the Assessment of Spondyloarthritis International Society works on spondyloarthritis in the last 15 years.Search for more papers by this authorPublished Online:24 Jul 2013https://doi.org/10.2217/ebo.13.135AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit View chapterAbstract: Ankylosing spondylitis (AS) is a chronic rheumatic disease of unknown etiology, strongly associated with HLA-B27. Most initial signs and symptoms result from an inflammatory process that takes place in the entheses and synovial membrane. During the course of the disease, the inflammatory pattern in most patients becomes intermittent, and the development of structural changes occurs at the bone area adjacent to the entheses and synovial membrane. Patients with AS complain of pain, stiffness, reduced mobility, decreased functioning and poor health-related quality of life (HRQoL). Physical examination discloses pain and tenderness when pressing the joints and entheses, and reduction of spinal and peripheral joint mobility, accompanied by some deformities and difficulties in performing daily life activities. The diagnosis of AS is made in patients complaining of back pain, reduced mobility of the spine and radiographic sacroiliitis. Most patients are diagnosed 8–10 years after onset, once structural bone changes of the sacroiliac joints have developed. Historically, the management of AS has been unsatisfactory for many patients. AS was considered a variant of rheumatoid arthritis that attracted the interest of very few investigators until the end of the 1960s. The efficacy of NSAIDs was limited and there was no evidence that disease-modifying antirheumatic drugs could change AS progression. By the end of the 1960s, AS became the prototype of the ‘seronegative spondarthritides’, which later was associated with HLA-B27, and then with gut inflammation. The development of proper clinical trials and outcome measures started between the 1970s and 1990s. The discovery of the presence of TNF-α RNA in the synovial membrane of the sacroiliac joints of patients with AS [1], and the significant improvement of symptoms with infliximab TNF-α blockers were milestones in the development of the spondyloarthritis (SpA) field [2]. Today, the best therapeutic option for controlling disease activity in patients with AS is the use of TNF-α blockers. In 2003, the Assessment of Spondyloarthritis International Society (ASAS) issued the first international consensus statement for the use of anti-TNF agents in patients with AS for the rheumatologist, and then for other doctors whose interest in the disease would ensure referral of patients with active and severe disease to the expert. These recommendations were updated in 2005 and 2010 [3]. In addition, in 2005 the ASAS group – in conjunction with the European League against Rheumatism (EULAR) – produced the first set of recommendations for the management of patients with AS to contribute to the improvement of outcomes by constructing evidence-based management recommendations, which were updated in 2010 (Figure 8.1) [4–7]. References1 Braun J , Bollow M , Neure L et al. Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ylosing spondylitis . Arthritis Rheum. 38 (4) , 499 – 505 (1995) . Crossref, Medline, CAS, Google Scholar2 Braun J , Brandt J , Listing J et al. Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial . Lancet 359 (9313) , 1187 – 1193 (2002) . Crossref, Medline, CAS, Google Scholar3 van der Heijde D , Sieper J , Maksymowych WP et al. Assessment of Spondyloarthritis International Society. 2010 update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis . Ann. Rheum. Dis. 70 (6) , 905 – 908 (2011) . Crossref, Medline, Google Scholar4 Zochling J , van der Heijde D , Dougados M et al. Current evidence for the management of ankylosing spondylitis: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis . Ann. Rheum. Dis. 65 (4) , 423 – 432 (2006) . Crossref, Medline, CAS, Google Scholar5 Braun J , van den Berg R , Baraliakos X et al. update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis . Ann. Rheum. Dis. 70 (6) , 896 – 904 (2011) . Crossref, Medline, CAS, Google Scholar6 van den Berg R , Baraliakos X , Braun J et al. First update of the current evidence for the management of ankylosing spondylitis with non-pharmacological treatment and non-biologic drugs: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis . Rheumatology (Oxf.) 51 (8) , 1388 – 1396 (2012) . Crossref, Medline, CAS, Google Scholar7 Baraliakos X , van den Berg R , Braun J et al. Update of the literature review on treatment with biologics as a basis for the first update of the ASAS/EULAR management recommendations of ankylosing spondylitis . Rheumatology (Oxf.) 51 (8) , 1378 – 1387 (2012) . Crossref, Medline, CAS, Google Scholar8 Dagfinrud H , Kvien TK , Hagen KB . Physiotherapy interventions for ankylosing spondylitis . Cochrane Database Syst. Rev. (1) , CD002822 (2008) . Medline, Google Scholar9 Wanders A , van der Heijde D , Landewe R et al. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: randomized clinical trial . Arthritis Rheum. 52 (6) , 1756 – 1765 (2005) . Crossref, Medline, CAS, Google Scholar10 Chen J , Liu C . Sulfasalazine for ankylosing spondylitis . Cochrane Database Syst. Rev. 2 , CD004800 (2005) . Google Scholar11 Gorman JD , Sack KE , Davis JC Jr . Treatment of ankylosing spondylitis by inhibition of tumor necrosis factor α . N. Engl. J. Med. 346 (18) , 1349 – 1356 (2002) . Crossref, Medline, CAS, Google Scholar12 van der Heijde D , Dijkmans B , Geusens P et al. Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo controlled trial (ASSERT) . Arthritis Rheum. 52 (2) , 582 – 591 (2005) . Crossref, Medline, CAS, Google Scholar13 van der Heijde D , Kivitz A , Schiff MH et al. Efficacy and safety of adalimumab in patients with ankylosing spondylitis: results of a multicenter, randomized, double-blind, placebo-controlled trial . Arthritis Rheum. 54 (7) , 2136 – 2146 (2006) . Crossref, Medline, CAS, Google Scholar14 Inman RD , Davis JC Jr , Heijde D et al. Efficacy and safety of golimumab in patients with ankylosing spondylitis: results of a randomized, double-blind, placebo-controlled, Phase III trial . Arthritis Rheum. 58 (11) , 3402 – 3412 (2008) . Crossref, Medline, CAS, Google Scholar15 Lambert RG , Salonen D , Rahman P et al. Adalimumab significantly reduces both spinal and sacroiliac joint inflammation in patients with ankylosing spondylitis: a multicenter, randomized, double-blind, placebo-controlled study . Arthritis Rheum. 56 (12) , 4005 – 4014 (2007) . Crossref, Medline, CAS, Google Scholar16 Davis JC , van der Heijde DM , Braun J et al. Sustained durability and tolerability of etanercept in ankylosing spondylitis for 96 weeks . Ann. Rheum. Dis. 64 (11) , 1557 – 1562 (2005) . Crossref, Medline, CAS, Google Scholar17 Baraliakos X , Listing J , Fritz C et al. Persistent clinical efficacy and safety of infliximab in ankylosing spondylitis after 8 years – early clinical response predicts long-term outcome . Rheumatology (Oxf.) 50 (9) , 1690 – 1699 (2011) . Crossref, Medline, CAS, Google Scholar18 Baraliakos X , Listing J , Brandt J et al. Radiographic progression in patients with ankylosing spondylitis after 4 yrs of treatment with the anti-TNF-α antibody infliximab . Rheumatology (Oxf.) 46 (9) , 1450 – 1453 (2007) . Crossref, Medline, CAS, Google Scholar19 Pedersen SJ , Chiowchanwisawakit P , Lambert RG , Østergaard M , Maksymowych WP . Resolution of inflammation following treatment of ankylosing spondylitisis associated with new bone formation . J. Rheumatol. 38 (7) , 1349 – 1354 (2011) . Crossref, Medline, CAS, Google Scholar20 Coates LC , Cawkwell LS , Ng NW et al. Real life experience confirms sustained response to long-term biologics and switching in ankylosing spondylitis . Rheumatology (Oxf.) 47 (6) , 897 – 900 (2008) . Crossref, Medline, CAS, Google ScholarFiguresReferencesRelatedDetails Advances in the Management of Ankylosing SpondylitisMetrics Downloaded 30 times History Published online 24 July 2013 Published in print July 2013 Information© Future Medicine Ltd© Future Medicine LtdPDF download" @default.
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