%0 Journal Article
%A Ramiro, Sofia
%A Nikiphorou, Elena
%A Sepriano, Alexandre
%A Ortolan, Augusta
%A Webers, Casper
%A Baraliakos, Xenofon
%A Landewe, Robert B M
%A Van den Bosch, Filip E
%A Boteva, Boryana
%A Bremander, Ann
%A Carron, Philippe
%A Ciurea, Adrian
%A van Gaalen, Floris A
%A Geher, Pal
%A Gensler, Lianne
%A Hermann, Josef
%A de Hooge, Manouk
%A Husakova, Marketa
%A Kiltz, Uta
%A Lopez-Medina, Clementina
%A Machado, Pedro M
%A Marzo-Ortega, Helena
%A Molto, Anna
%A Navarro-Compan, Victoria
%A Nissen, Michael J
%A Pimentel-Santos, Fernando M
%A Poddubnyy, Denis
%A Proft, Fabian
%A Rudwaleit, Martin
%A Telkman, Mark
%A Zhao, Sizheng Steven
%A Ziade, Nelly
%A van der Heijde, Desiree
%T ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update.
%D 2022
%U http://hdl.handle.net/10668/20132
%X To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6-8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.
%K Biological therapy
%K Spondyloarthritis
%K Therapeutics
%~