Rheumatology Advance Access originally published online on May 18, 2005
Rheumatology 2005 44(7):939-947; doi:10.1093/rheumatology/keh669
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Published by Oxford University Press on behalf of the British Society for Rheumatology 2005.
GUIDELINES |
BSR guidelines for prescribing TNF-
blockers in adults with ankylosing spondylitis. Report of a working party of the British Society for Rheumatology
Northwick Park Hospital, Harrow, 1 Leeds General Infirmary, Leeds, 2 RNHRD, Bath, 3 Norfolk and Norwich Hospital, Norwich, 4 St Thomas' Hospital, London, 5 National Ankylosing Spondylitis Society, Mayfield, 6 University of Glasgow and Glasgow Royal Infirmary, Glasgow and 7 University of Oxford and Nuffield Orthopaedic Centre, Oxford, UK.
Correspondence to: A. Keat, Arthritis Centre, Northwick Park Hospital, Harrow, Middlesex, AAI 30J, UK. E-mail: andrew.keat@nwlh.nhs.uk
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Introduction |
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Two TNF-blocking drugs are now licensed for the treatment of ankylosing spondylitis (AS) and there is clear evidence of symptomatic efficacy. It is recognized that the instruments for analysing aspects of AS and the outcomes of treatment are imperfect, though they are validated and adequate for the purpose.
This document provides guidance to enable consultant rheumatologists in the UK to balance the demonstrated merits of TNF blockade treatment against the known and unknown potential toxicity.
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Background |
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AS is an inflammatory condition primarily affecting the spine. Onset is most common in the third decade of life, though the disease may remain symptomatic and progressive throughout life. It is part of the family of spondyloarthropathies, which also includes psoriatic arthritis, reactive arthritis and enteropathic arthritis. Undifferentiated forms of spondyloarthopathy, often presenting as mono- or oligoarthritis, are also recognized, as are juvenile forms of spondyloarthopathy, in which the spine is not affected but may
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Prevalence and incidence of ankylosing spondylitis |
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Clinical impact of AS |
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Economic and social impact of AS |
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Employment
Health economics
Quality of life
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Conventional treatment for AS |
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Instruments for the diagnosis and assessment of AS |
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Current TNF-blocking agents
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Clinical efficacy of TNF blockade treatment in AS |
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Spinal disease
Peripheral arthritis
Peripheral enthesitis
Effect on ankylosis
Related conditions
Inflammatory bowel disease
Uveitis
Psoriasis
Effect on bone mineral density (BMD)
Imaging
Histological findings
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Toxicity |
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These guidelines |
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Treatment guideline |
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Eligibility for treatment with TNF-blocking drugs
Exclusions from treatment
Criteria for withdrawal of therapy
Definition of response to treatment
Treatment regimes
Central registry of data
Review of these guidelines
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Appendix 1. Members and affiliations of the working group |
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Appendix 2. Process of review and appraisal of this draft |
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Appendix 3. Declaration of interest statement |
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Appendix 4. Other guidelines and documents which should be read in conjunction with this document |
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