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


CONCLUSIONS
These clinical practice recommendations should help rheumatologists in their everyday decisions regarding the use of TNFalpha antagonist therapy in patients with AS or PsA.
Pham
Thao
T
Service de Rhumatologie, CHU de la Conception, 147, bd Baille, 13005 Marseille, France. thao.pham@ap-hm.fr
Guillemin
Francis
F
Claudepierre
Pascal
P
Luc
Mathieu
M
Miceli-Richard
Corinne
C
Fautrel
Bruno
B
de Bandt
Michel
M
Breban
Maxime
M
Goupille
Philippe
P
Maillefert
Jean-Francis
JF
Masson
Charles
C
Saraux
Alain
A
Schaeverbeke
Thierry
T
Wendling
Daniel
D
Mariette
Xavier
X
Combe
Bernard
B
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000188:drug therapy*; D005602:France; D006801:Humans; D012219:Rheumatology / Q000592:standards*; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha