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You are here: Home / Articles / New Diagnostic Criteria for Axial Spondylarthritis

New Diagnostic Criteria for Axial Spondylarthritis

February 3, 2012 • By Ann Kepler

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Exercise, including physical therapy, improves function and decreases pain. Dr. Khan recommended swimming as the best exercise for SpA patients. The exercise should not be short-term but rather the beginning of a lifelong exercise program, which is necessary in the management of a chronic condition.

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ASAS recommendations on managing SpA suggest using anti-TNF agents in patients with SpA, but only after:

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  • A regimen of NSAIDs (at least two different drugs tried for one month or more total);
  • An adequate therapeutic trial of a disease-modifying antirheumatic drug (DMARD), preferably sulfasalazine, for patients with peripheral symptoms; and
  • An efficacy evaluation of the above steps after 12 weeks.6

Note that patients with axial spondylarthritis do not need to take a DMARD before or concomitant with an anti-TNF agent.

All TNF inhibitors are remarkably effective as monotherapy for treating SpA, and the response is even better in early disease. TNF inhibitors have long-term efficacy and an acceptable safety profile, but there is a need for adequate intake of vitamin D and calcium and for ongoing screening for concomitant osteopenia and osteoporosis.

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Ann Kepler is a medical journalist based in Chicago.

References

  1. Grigg SE, Martin BJ, Buchanan RR, Schachna L. Burden of delay to diagnosis of ankylosing spondylitis. [abstract]. Arthritis Rheum. 2011;63(Suppl 10):1308.
  2. Brown MA. The evolving roles of genes and gene expression profiling in ankylosing spondylitis. Ann Rheum Dis. 2011;70(Suppl 3);7.
  3. Sieper J, van der Heijde D, Landewé R, et al. New criteria for inflammatory back pain in patients with chronic back pain: A real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis. 2009;68:784-788.
  4. Rudwaleit M, van der Heijde D, Khan MA, Braun J, Sieper J. How to diagnose axial spondyloarthritis early. Ann Rheum Dis. 2004;63:535-543.
  5. Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis. 2009;68:777-783.
  6. Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: A guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68(Suppl II):ii1–ii44.

Pages: 1 2 3 | Single Page

Filed Under: Conditions, Guidelines, Spondyloarthritis Tagged With: ACR/ARHP Annual Meeting, Ankylosing Spondylitis, antiinflammatory, axial spondyloarthritis (SpA), Diagnostic Criteria, imaging, Pain, patient care, Reactive arthritis, SafetyIssue: February 2012

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