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PubMed2004

Relationship between some acute phase reactants and the Bath Ankylosing Spondylitis Disease Activity Index in patients with ankylosing spondylitis.

OBJECTIVES: The aims of this study were to investigate a possible relationship between the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and some acute phase reactant (APR) levels in patients with ankylosing spondylitis (AS). METHODS: Twenty outpatients who fulfilled the modified New York criteria for AS were included in the study. Laboratory activity was assessed by examining erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), haptoglobin (Hp), and beta2 microglobulin (beta2MG). Disease activity was assessed according to the BASDAI, which includes a 10-point visual analogue scale to measure pain, fatigue, morning stiffness, swelling, and areas of local tenderness. RESULTS: When APR values were analyzed for the BASDAI, a positive correlation between CRP and BASDAI was observed (r = 0.556, P < 0.05). There was no clear, statistically significant correlation between BASDAI and the other APRs (ESR, r = 0.328, P > 0.05; Hp, r = 0.035, P > 0.05; and beta2MG, r = -0.190, P > 0.05). CONCLUSIONS: Our data suggest that CRP is a better marker of disease activity than ESR, Hp, and beta2MG.

Adult↗
PubMed1999

Selection of instruments in the core set for DC-ART, SMARD, physical therapy, and clinical record keeping in ankylosing spondylitis. Progress report of the ASAS Working Group. Assessments in Ankylosing Spondylitis.

To select specific instruments for each domain of the core set for endpoints in ankylosing spondylitis (AS), we gathered all instruments described in the literature to assess the domains chosen as endpoints in AS and sent them to 43 members of the Assessments in Ankylosing Spondylitis (ASAS) Working Group. The following domains were taken into account: function, pain, spinal mobility, patient global assessment, morning stiffness, peripheral joints and entheses, acute phase reactants, x-ray spine, x-ray hips, fatigue. For each instrument the members were asked to judge if the instrument was feasible and relevant. If an instrument was judged to be not feasible or not relevant by more than 50% of the respondents the instrument was deleted from the list. These data were presented during an ASAS workshop and the final decisions were about which instruments to include in the core set. This process was repeated separately for the settings disease controlling antirheumatic therapy (DC-ART), symptom modifying antirheumatic drugs (SMARD) and physical therapy, and clinical record keeping. The response rate to the questionnaire was 72%. For each domain one or more instruments were selected, except for Entheses and Fatigue. The chosen instruments were similar for the 3 above settings. Core sets of specific instruments were selected for the OMERACT filter test for relevance and feasibility. For all these instruments the remaining aspects of the OMERACT filter (truth and discrimination) should be assessed by literature review and if needed by additional research. It is recommended to use these instruments in all research projects in AS.

Antirheumatic Agents↗
PubMed2000

The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the bath ankylosing spondylitis radiology hip index.

OBJECTIVE: To develop a simple but reproducible radiological scoring system for the hip in ankylosing spondylitis (AS). METHODS: A consensus approach was used to develop a grading system whereby hip radiographs of 470 patients with AS were scored from 0 to 4 (normal, suspicious, mild, moderate, and severe), producing the Bath Ankylosing Spondylitis Radiology Hip Index ( BASRI-hip or BASRI-h). The system was designed to be specific for AS radiographic change at the hip and includes circumferential joint space narrowing, osteophytes, erosions, and protrusio acetabulae. This score can then be added to the BASRI-spine, forming the grading system BASRI-total, scored 2-16. Radiographs of 134 patients were used to test reproducibility. Blinded radiographs of 100 non-AS patients were included randomly to assess disease specificity. Sensitivity to change was determined using 438 radiographs from 122 patients, over 219 time intervals. RESULTS: Inter and intraobserver variation for the right and left hip showed 83-84% and 94-96% complete agreement, respectively. Disease specificity was 0.76. If non-AS patients with a total hip replacement were excluded, disease specificity was 0.83. Sensitivity to change became apparent at one year (p < 0.001). Grading the hips using a single radiograph takes seconds. CONCLUSION: BASRI-h is a reliable method for grading hip radiographic change in AS. It is disease-specific, sensitive to change, simple to use, and rapid to perform.

Female↗
PubMed2001

[Differences between tuberculous spondylitis and brucellar spondylitis].

OBJECTIVE: To identify potential differences in the clinical and laboratory characteristics between tuberculous spondylitis (TS) and brucellar spondylitis (BS). PATIENTS AND METHODS: Retrospective study of patients with TS and BS diagnosed in our hospital between january 1992 and december 1998. RESULTS: TS was diagnosed in 17 patients and BS in 10 patients. In our series, a higher delay in the diagnosis (27.9 +/- 24.6 vs. 16 +/- 5.6 weeks, p = 0.02) was found in TS. There was a higher frequency, but without stadistic significance, of immunosuppression, one or several paravertebral or epidural abscesses, spinal cord compression, anemia and an elevated erythrocyte sedimentation rate in TS, and a higher frequency of fever/febricule and residual vertebral pain in BS. Lumbar location was the most frequent in both groups (58.8% in TS and 70% in BS). CONCLUSIONS: It is possible that there were some differences in the clinical and laboratory characteristics between TS and BS which may be an aid in the differential diagnosis of both entities and orient the empirical treatment in these cases without a definitive microbiological diagnosis or while awaiting the diagnostic confirmation.

Adolescent↗
PubMed1975

[Differentiation of spondylitis ankylopoietica and spondylitis hyperostotica].

Changes in the bodies of vertebrae in ancylopoetic spondylitis (Bekhterev's disease) and in hyperostotic spondylitis (Forestier's disease) may be very similar, in particular as regards the ancylotic connection of the bodies of the vertebrae and syndesmophytes. In the differential diagnosis the following differences are important: Syndesmophytes in Bekhterev's disease are symetrical and continuous, there is ossification of the intervertebral discs, and ancylosis affects always sacroiliac, intervertebral and costovertebral joints. In hyperostotic spondylosis the sclerotic syndesmophytes bulge in a lateral direction, mainly to the right. The inveretebral discs do not ossify, the sacroilliac and other above mentioned joints are not affected.

Aged↗
PubMed2002

Measuring disability in ankylosing spondylitis: comparison of bath ankylosing spondylitis functional index with revised Leeds Disability Questionnaire.

OBJECTIVE: Disability has been identified as a core outcome measure in ankylosing spondylitis (AS). The Dougados Functional Index (DFI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) have been selected as core measures of function in this disease. However, neither of these instruments has undergone rigorous psychometric testing. METHODS: The psychometric properties of 2 measures of disability, the BASFI and the revised Leeds Disability Questionnaire (RLDQ), were compared in a cohort of 208 outpatients with AS. Rasch analysis was used to examine the properties of each measure and to compare them on a common scale. Test-retest was assessed in a cohort of 149 subjects who completed each instrument twice over an interval of 2 weeks. RESULTS: Both instruments gave an even spread of scores across the study group, but BASFI responses were positively skewed and RLDQ responses negatively skewed. There was a highly significant difference between perceived severity groups for both instruments (Kruskal-Wallis chi-squared: RLDQ, 75.1; BASFI, 80.4; both p < 0.0001). Both instruments gave acceptable test-retest scores (RLDQ ICC = 0.95, 95% CI 0.93-0.97; BASFI ICC = 0.94, 95% CI 0.92-0.96). Both instruments were found to be unidimensional according to the Rasch model, but the BASFI had more items displaying differential item functioning. Category disordering was apparent with the BASFI but not the RLDQ. However, both instruments displayed disordered item thresholds. Neither instrument can be used as an interval measure. Both measures had "towers" of thresholds whereby several thresholds were marking the same point on the underlying disability construct. This was particularly notable in the case of the BASFI. CONCLUSION: Both the BASFI and RLDQ provide a unidimensional measure of function in AS that is in accord with patient perception of disease severity. Neither instrument can be used as an interval measure. Changing the way that the instruments are scored, for example by collapsing categories, may improve their performance.

Activities of Daily Living↗
PubMed2002

Juvenile onset ankylosing spondylitis (JAS) has less severe spinal disease course than adult onset ankylosing spondylitis (AAS): clinical comparison between JAS and AAS in Korea.

OBJECTIVE: To assess the frequency of juvenile onset ankylosing spondylitis (JAS) in Korean patients with AS and to differentiate the clinical characteristics of JAS from adult onset ankylosing spondylitis (AAS). METHODS: We studied 98 consecutive patients with AS who visited the rheumatology clinic of a tertiary referral center and compared clinical and radiographic features of JAS (n = 41) with those of AAS (n = 57). RESULTS: Median age at onset in JAS was 14 years (range 7-16) and in AAS 22 years (range 17-38) (p < 0.01). Patients with JAS at presentation showed fewer spinal symptoms and more frequent peripheral joint symptoms than those with AAS (41.5% vs 80.7% and 73.2% vs 36.8%, respectively; p < 0.01). Current cervical spine disease was more frequent in AAS (66.7% vs 43.9%; p = 0.02) and current knee disease in JAS (26.8% vs 8.8%; p = 0.02). Patients with JAS showed a shorter tragus-wall distance (mean +/- SD 10.6 +/- 1.7 vs 13.1 +/- 6.9 cm; p < 0.01), more mobility on the modified Schober test (5.7 +/- 2.0 vs 4.0 +/- 2.6 cm; p < 0.01) and chest expansion (4.4 +/- 1.7 vs 3.2 +/- 1.8 cm; p < 0.01), and a better forced vital capacity (75.1 +/- 14.1% vs 82.1 +/- 16.1% of predicted value; p = 0.03) than those with AAS. Totally ankylosed sacroiliitis and spinal syndesmophyte on radiographs were less frequent in JAS patients than in AAS (19.5% vs 47.4% and 17.1% vs 54.4%, respectively; p < 0.01). CONCLUSION: The frequency of JAS (41.3%) among Koreans was higher than that reported for Caucasians. General joint involvement pattern at disease onset in JAS was similar to previous reports. Our data suggest that clinically and radiographically JAS has a less severe spinal disease course than AAS.

Adolescent↗
PubMed2005

Selection of a method for scoring radiographs for ankylosing spondylitis clinical trials, by the Assessment in Ankylosing Spondylitis Working Group and OMERACT.

Radiographs are important for assessing structural damage in patients with ankylosing spondylitis (AS); this technology was selected by the international ASsessment in Ankylosing Spondylitis (ASAS) Working Group as an important domain for assessing outcome in clinical trials. The selection of a preferred scoring method based on the OMERACT filter still needs to be undertaken. This article describes the scientific basis for and process of making the selection. Finally, both the ASAS Working Group and OMERACT participants voted for the modified Stoke AS Spinal Score (mSASSS) as the preferred scoring method for use in clinical trials in AS.

Clinical Trials as Topic↗
PubMed1994

A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index.

OBJECTIVE: After pain and stiffness, one of the most important complaints of patients with ankylosing spondylitis (AS) is disability. The main aims of treatment are to control pain but also to improve function. Various methods of assessing function exist but are either not specific for the disease or have not been adequately validated. As a result of this deficiency we developed the Bath Ankylosing Spondylitis Functional Index (BASFI) as a new approach to defining and monitoring functional ability in patients with AS. METHODS: This self-assessment instrument was designed by a team of medical professionals in conjunction with patients, and consists of 8 specific questions regarding function in AS and 2 questions reflecting the patient's ability to cope with everyday life. Each question is answered on a 10 cm horizontal visual analog scale, the mean of which gives the BASFI score (0-10). The questionnaire was completed 257 times in total: once by 116 outpatients and by 47 inpatients on 3 occasions over a 3-week intensive physiotherapy course. In addition, the instrument was compared with the Dougados functional index. RESULTS: Patients scores covered 95% of the BASFI range, giving a normal distribution of results. In contrast only 65% of the Dougados functional index scale was used. Furthermore, over the 3 week period of inpatient treatment, the BASFI revealed a significant improvement in function (20%, p = 0.004) while there was a less impressive change in the Dougados functional index (6%, p = 0.03). This demonstrates the superior sensitivity of the BASFI: Consistency was good for both indices (p < 0.001), as was the relationship between patient perception of function and function as assessed by an external observer (p < 0.001). CONCLUSION: The BASFI satisfies the criteria required of a functional index: it is quick and easy to complete, is reliable and is sensitive to change across the whole spectrum of disease.

Activities of Daily Living↗
PubMed1994

A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index.

OBJECTIVE: Disease status, in terms of disease activity, disease progression and prognosis is difficult to define in ankylosing spondylitis (AS). No gold standard exists. Therefore, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), a self-administered instrument, has been developed as a new approach to defining disease activity in patients with AS. METHODS: The index, designed by a multidisciplinary team with input from patients, consists of six 10 cm horizontal visual analog scales to measure severity of fatigue, spinal and peripheral joint pain, localized tenderness and morning stiffness (both qualitative and quantitative). The final BASDAI score has a range of 0 to 10. The index was distributed to a cross section of patients, including inpatients receiving 3 weeks of intensive physiotherapy treatment and hospital outpatients. BASDAI was completed by a total of 154 patients. Validation of the new instrument was achieved through analysis of user friendliness, reliability (consistency), score distribution and sensitivity to change. Comparisons were made with a previous Bath disease activity index (DAI) and the Newcastle Enthesis Index. RESULTS: The BASDAI was found by patients to be quick and simple to complete (mean: 67 s). Test-retest reliability was good (r = 0.93; p < 0.001), as was the distribution of scores across the scale (score range: 0.5-10; mean: 4.31). BASDAI was sensitive to change, reflecting a 16% (mean) improvement in inpatient scores after 3 weeks of treatment. It is superior to the DAI in terms of construct and content validity and to the Enthesis Index in all aspects. CONCLUSION: In summary, BASDAI is user friendly, reliability, sensitive to change and reflects the entire spectrum of disease. It is a comprehensive self-administered instrument for assessing disease activity in AS.

Data Interpretation, Statistical↗
PubMed1999

Quality of life in ankylosing spondylitis: validation of the ankylosing spondylitis Arthritis Impact Measurement Scales 2, a modified Arthritis Impact Measurement Scales Questionnaire.

OBJECTIVE: To develop a questionnaire measuring quality of life in ankylosing spondylitis (AS). METHODS: A focus group technique contributed to the generation of an AS-specific questionnaire using the Arthritis Impact Measurement Scales 2 (AIMS2) (12 dimensions), supplemented with items from the Health Assessment Questionnaire for the Spondylar-thropathies, as well as original new items. Patients from a self-help group provided data to assess the validity (n = 146) and reproducibility (n = 43) of the AS-AIMS2. RESULTS: The focus group generated a thirteenth dimension including 6 items labeled "spine mobility." Principal component analyses on AS-AIMS2 showed satisfactory dimensionality (74.1% of variance explained), high internal consistency (Cronbach's alpha = 0.78-0.91), significant convergent validity of the new dimension with spine pain and mobility, and good reproducibility in the 13 dimensions and 5 components (intraclass correlation coefficient = 0.7-0.9). The scores in each component of the AS-AIMS2 showed a marked deterioration of quality of life in these young patients. CONCLUSIONS: The disease-specific AS-AIMS2 questionnaire should help improve care management in AS.

Activities of Daily Living↗
PubMed2001

Ankylosing spondylitis assessment group preliminary definition of short-term improvement in ankylosing spondylitis.

OBJECTIVE: To develop criteria for symptomatic improvement in patients with ankylosing spondylitis (AS), using outcome domain data from placebo-controlled clinical trials of nonsteroidal antiinflammatory drugs (NSAIDs). METHODS: Patient data from 5 short-term, randomized, controlled trials were used to assess equivalence, reliability, and responsiveness of multiple items in the 5 outcome domains for AS treatment: physical function, pain, spinal mobility, patient global assessment, and inflammation. At least one measure per domain was responsive (standardized response mean of > 0.5), except for the spinal mobility domain, which was omitted from the criteria. We developed and tested candidate improvement criteria in a random two-thirds subset from the 3 largest trials and used the remaining one-third for validation. These 3 largest trials included 923 patients (631 receiving NSAIDs, 292 in placebo groups). We selected the multiple domain definition that best distinguished NSAID treatment from placebo by chi-square test and that had a placebo response rate of < or = 25%. RESULTS: Candidate definitions were changes in single domains and in multiple measure indices, as well as combinations of improvements in multiple domains. Worsening in a domain was defined as a change for the worse of > or = 20% and a net change for the worse of > or = 10 units on a scale of 0-100. Partial remission (for comparison purposes) was defined as an end-of-trial value of < 20/100 in each of the 4 domains. Among 20 candidate criteria, change of > or = 20% and > or = 10 units in each of 3 domains and absence of worsening in the fourth discriminated best in the development subset (51% of patients improved with NSAIDs, 25% with placebo; chi2 = 36.4, P < 0.001). Results were confirmed in the validation subset. Almost all patients satisfying the definition of partial disease remission at the end of the trial had also improved by this criterion. Among all 923 patients, improvement rates using this criterion were 49% for NSAID-treated patients and 24% for placebo-treated patients. CONCLUSION: Although further validation using data from new trials is still needed, we conclude that we have developed a clinically valid, easy-to-use measure of short-term improvement in AS.

Adult↗
PubMed1984

The risk of developing ankylosing spondylitis in HLA-B27 positive individuals. A comparison of relatives of spondylitis patients with the general population.

The present study was performed on 61 HLA-B27 positive first-degree relatives and 40 HLA-B27 negative relatives of 20 HLA-B27 positive probands with ankylosing spondylitis (AS). Of 24 HLA-B27 positive relatives 45 years or older, 21% had AS and 38% sacroiliitis. The HLA-B27 negative relatives did not have features of either disease. In the population study of 2,957 individuals 45 years or older, we found 5 cases of HLA-B27 positive sacroiliitis (according to the New York criteria) and 3 of these fulfilled the New York criteria for diagnosis of AS. In 2 of these 3 individuals, the diagnosis was made on clinical grounds. The phenotype frequency of HLA-B27 in this population is 7.8%, or about 230 HLA-B27 positive individuals in this population sample. Since AS was found in only 3 individuals, 1.3% of the HLA-B27 positive individuals in the population at large have AS; therefore, our data show that among individuals 45 years or older, 21% of HLA-B27 positive relatives of HLA-B27 positive AS patients have AS as compared with 1.3% of the HLA-B27 positive individuals in the population at large. Thus, the risk for AS is 16 times greater in the HLA-B27 positive relatives compared with HLA-B27 positive individuals in the population at large. The discriminatory value of the New York criterion of history of pain or the presence of pain at the dorsolumbar junction or in the lumbar spine was analyzed in the population and family studies and was found to be too nonspecific.

Adolescent↗
PubMed2004

The influence of peripheral arthritis on disease activity in ankylosing spondylitis patients as measured with the Bath Ankylosing Spondylitis Disease Activity Index.

OBJECTIVES: To assess the differences in disease activity as measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) between patients with and without peripheral arthritis/enthesitis. To investigate whether scores on the BASDAI change by omitting the 2 questions on peripheral disease. METHODS: Disease activity was assessed on a 10-cm visual analog scale and by BASDAI. Alternative BASDAIs were constructed by omitting the peripheral joints question and/or the enthesitis question. Correlations between the alternative BASDAIs and other measures of disease activity were calculated. Generalized estimating equations (GEE) were used to assess whether having peripheral arthritis influenced BASDAI and alternative BASDAI scores, and to assess whether peripheral arthritis influenced the score of the individual questions of the BASDAI. RESULTS: At baseline, the BASDAI was calculated in 214 patients. In patients with peripheral arthritis (n = 56), the mean (SD) BASDAI score was 4.4 (2.3) as compared with 3.1 (1.9) (P < 0.0001) in the patients without peripheral arthritis (n = 158). The relationship between arthritis and the BASDAI score appeared to be truly longitudinal (GEE regression coefficient beta = 0.64; 95% confidence interval 0.28-1.00). Peripheral arthritis was significantly longitudinally associated with all separate item scores of the BASDAI. Omitting the peripheral joints and/or enthesitis question from the BASDAI questionnaire only partially explained the difference in BASDAI score between the 2 groups. CONCLUSION: Disease activity measured by the BASDAI is higher in patients with concomitant peripheral disease compared with patients with disease restricted to the axial skeleton. The increased BASDAI score in patients with peripheral arthritis is partially explained by increased overall disease activity as well as by a disproportionate contribution of the peripheral joints question to the overall score.

Adult↗
PubMed2003

Juvenile ankylosing spondylitis--is it the same disease as adult ankylosing spondylitis?

OBJECTIVES: Juvenile and adult forms of ankylosing spondylitis (AS) have been shown to have different clinical presentation and outcome in Caucasians. We did this retrospective analysis to see if similar differences exist in the Indian population. PATIENTS AND METHODS: Case records of 210 Indian patients diagnosed with AS according to modified New York criteria were reviewed. Data were collected regarding age of onset, clinical features, drug treatment, and outcome at last follow-up. Patients with onset before 17 years of age were classified as having juvenile AS (JAS) and the rest with adult AS (AAS). RESULTS: There were 150 patients with AAS and 60 with JAS. The latter had higher male preponderance, more frequent onset with peripheral arthritis, and greater involvement of hip and knee joints. Valvular dysfunction was seen only in patients with JAS. CONCLUSION: In this group of subjects, juvenile AS had onset more often with oligoarthritis and enthesitis than with spinal disease. Hip and knee joint involvement was more common in JAS than AAS.

Adolescent↗
PubMed2005

Ankylosing spondylitis and heart abnormalities: do cardiac conduction disorders, valve regurgitation and diastolic dysfunction occur more often in male patients with diagnosed ankylosing spondylitis for over 15 years than in the normal population?

The objective of this study was to determine the rate of selected cardiac pathologies (conduction disorders, valve regurgitation and diastolic dysfunction) in patients with long-standing ankylosing spondylitis (AS) and compare the results with the prevalence in the normal population. A rheumatologic (structured questionnaire interview) and cardiac evaluation (resting electrocardiography and echocardiography) was performed in 100 male subjects with AS and a disease duration of more than 15 years. The rates for conduction disorders, aortic and mitral valve regurgitation and diastolic dysfunction were compared with the corresponding results in the literature among the normal population. In patients with long-standing AS there was no increased rate for valve regurgitation (mitral and aortic valve) and for arrhythmia. Diastolic dysfunction occurred more often in patients with long-standing AS. However, this might be caused by the presence of other cardiovascular risk factors such as age and hypertension. According to these results, a cardiologic evaluation with echocardiography should not be recommended routinely in patients with long-standing AS. To confirm these results, a large prospective study with patients with long-standing AS and with a matched control group should be performed in the future.

Adult↗
PubMed1996

Radiological outcome in ankylosing spondylitis: use of the Stoke Ankylosing Spondylitis Spine Score (SASSS).

We investigated the role of the Stoke Ankylosing Spondylitis Spine Score (SASSS) in a longitudinal cohort study of 53 patients with AS, assessed 9 yr apart, and its relation to clinical, functional and laboratory measures of disease activity and outcome. We also examined the long-term predictive value of quantitative sacroiliac scintigraphy (QSS). SASSS correlated closely with clinical measures, including occiput-wall distance (OWD) (P < 0.001) and modified Schober (P < 0.001). QSS was significantly correlated with final X-ray score (P < 0.05). SASSS changed significantly (P < 0.001) over the study period; two patterns of change in spine score were discernible, one with little change in radiological score and the other showing marked progression. The SASSS is a useful, valid score, which correlates with clinical outcomes measures and which has identified specific patterns of radiographic progression in AS.

Adult↗
PubMed2005

Current evidence for the management of ankylosing spondylitis: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis.

OBJECTIVE: To assess available management strategies in ankylosing spondylitis (AS) using a systematic approach, as a part of the development of evidence based recommendations for the management of AS. METHODS: A systematic search of Medline, Embase, CINAHL, PEDro, and the Cochrane Library was performed to identify relevant interventions for the management of AS. Evidence for each intervention was categorised by study type, and outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. The effect size, rate ratio, number needed to treat, and incremental cost effectiveness ratio were calculated for each intervention where possible. Results from randomised controlled trials were pooled where appropriate. RESULTS: Both pharmacological and non-pharmacological interventions considered to be of interest to clinicians involved in the management of AS were identified. Good evidence (level Ib) exists supporting the use of non-steroidal anti-inflammatory drugs (NSAIDs) and coxibs for symptomatic treatment. Non-pharmacological treatments are also supported for maintaining function in AS. The use of conventional antirheumatoid arthritis drugs is not well supported by high level research evidence. Tumour necrosis factor inhibitors (infliximab and etanercept) have level Ib evidence supporting large treatment effects for spinal pain and function in AS over at least 6 months. Level IV evidence supports surgical interventions in specific patients. CONCLUSION: This extensive literature review forms the evidence base considered in the development of the new ASAS/EULAR recommendations for the management of AS.

Anti-Inflammatory Agents, Non-Steroidal↗