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TNFalpha antagonist therapy in ankylosing spondylitis and psoriatic arthritis: recommendations of the French Society for Rheumatology.

Abstract：

OBJECTIVES:To develop recommendations for TNFalpha antagonist therapy in patients with spondyloarthropathies. METHODS:The Delphi consensus procedure was used to select questions, to which evidence-based answers were sought in the literature. Expert opinion was used when needed to estimate the risks and benefits of TNFalpha antagonists. TNFalpha antagonists exert potent antiinflammatory effects but fail to provide a definitive cure. RESULTS:Recommendations were developed for patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA). The following criteria for TNFalpha antagonist therapy were selected: definitive diagnosis of AS or PsA, active disease for at least 4 consecutive weeks documented during two physician visits, overall physician's assessment of disease activity>/=4/10 and BASDAI>/=4/10 in axial disease or at least three tender and swollen joints in peripheral disease, failure to respond adequately to at least three nonsteroidal antiinflammatory drugs given in optimal dosages for at least 3 months in axial disease or at least one disease-modifying antirheumatic drug (methotrexate, leflunomide, sulfasalazine) for at least 4 months, with local glucocorticoid injections if appropriate, in peripheral disease. Effectiveness and safety should be evaluated by a rheumatologist. The frequency of monitoring depends on the drug. Lack of effectiveness should be defined as inadequate improvement after 6-12 weeks, with a less than two-point decrease in the BASDAI in axial disease or a less than 30% decrease in the tender and swollen joint counts in peripheral disease. CONCLUSION:These clinical practice recommendations should help rheumatologists in their everyday decisions regarding the use of TNFalpha antagonist therapy in patients with AS or PsA.

journal_name

Joint Bone Spine

journal_title

Joint bone spine

authors

Pham T,Guillemin F,Claudepierre P,Luc M,Miceli-Richard C,Fautrel B,de Bandt M,Breban M,Goupille P,Maillefert JF,Masson C,Saraux A,Schaeverbeke T,Wendling D,Mariette X,Combe B,Club Rhumatismes et Inflammation (CRI).,Soci

doi

10.1016/j.jbspin.2006.02.005

subject

Has Abstract

pub_date

2006-10-01 00:00:00

pages

547-53

issue

eissn

1297-319X

issn

1778-7254

pii

S1297-319X(06)00142-4

journal_volume

pub_type

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TNFalpha antagonist therapy in ankylosing spondylitis and psoriatic arthritis: recommendations of the French Society for Rheumatology.