title: ASAS/EULAR recommendations for the management of ankylosing spondylitis.
abstract: OBJECTIVE
  To develop evidence based recommendations for the management of ankylosing spondylitis (AS) as a combined effort of the 'ASsessment in AS' international working group and the European League Against Rheumatism.
  
  
  METHODS
  Each of the 22 participants was asked to contribute up to 15 propositions describing key clinical aspects of AS management. A Delphi process was used to select 10 final propositions. A systematic literature search was then performed to obtain scientific evidence for each proposition. Outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. The effect size, relative risk, number needed to treat, and incremental cost effectiveness ratio were calculated. On the basis of the search results, 10 major recommendations for the management of AS were constructed. The strength of recommendation was assessed based on the strength of the literature evidence, risk-benefit trade-off, and clinical expertise.
  
  
  RESULTS
  The final recommendations considered the use of non-steroidal anti-inflammatory drugs (NSAIDs) (conventional NSAIDs, coxibs, and co-prescription of gastroprotective agents), disease modifying antirheumatic drugs, treatments with biological agents, simple analgesics, local and systemic steroids, non-pharmacological treatment (including education, exercise, and physiotherapy), and surgical interventions. Three general recommendations were also included. Research evidence (categories I-IV) supported 11 interventions in the treatment of AS. Strength of recommendation varied, depending on the category of evidence and expert opinion.
  
  
  CONCLUSIONS
  Ten key recommendations for the treatment of AS were developed and assessed using a combination of research based evidence and expert consensus. Regular updating will be carried out to keep abreast of new developments in the management of AS.
authors.affiliation: Rheumazentrum-Ruhrgebiet, St Josefs-Krankenhaus, Landgrafenstr 15, 44652 Herne, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Zochling
authors.forename: D
authors.initials: D
authors.lastname: van der Heijde
authors.forename: R
authors.initials: R
authors.lastname: Burgos-Vargas
authors.forename: E
authors.initials: E
authors.lastname: Collantes
authors.forename: J C
authors.initials: JC
authors.lastname: Davis
authors.forename: B
authors.initials: B
authors.lastname: Dijkmans
authors.forename: M
authors.initials: M
authors.lastname: Dougados
authors.forename: P
authors.initials: P
authors.lastname: Géher
authors.forename: R D
authors.initials: RD
authors.lastname: Inman
authors.forename: M A
authors.initials: MA
authors.lastname: Khan
authors.forename: T K
authors.initials: TK
authors.lastname: Kvien
authors.forename: M
authors.initials: M
authors.lastname: Leirisalo-Repo
authors.forename: I
authors.initials: I
authors.lastname: Olivieri
authors.forename: K
authors.initials: K
authors.lastname: Pavelka
authors.forename: J
authors.initials: J
authors.lastname: Sieper
authors.forename: G
authors.initials: G
authors.lastname: Stucki
authors.forename: R D
authors.initials: RD
authors.lastname: Sturrock
authors.forename: S
authors.initials: S
authors.lastname: van der Linden
authors.forename: D
authors.initials: D
authors.lastname: Wendling
authors.forename: H
authors.initials: H
authors.lastname: Böhm
authors.forename: B J
authors.initials: BJ
authors.lastname: van Royen
authors.forename: J
authors.initials: J
authors.lastname: Braun
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D015444:Exercise; D006801:Humans; D007391:International Cooperation; D026741:Physical Therapy Modalities; D013167:Spondylitis, Ankylosing / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha