title: TNFalpha antagonist therapy in ankylosing spondylitis and psoriatic arthritis: recommendations of the French Society for Rheumatology.
abstract: 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.
authors.affiliation: Service de Rhumatologie, CHU de la Conception, 147, bd Baille, 13005 Marseille, France. thao.pham@ap-hm.fr
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
authors.forename: Pascal
authors.initials: P
authors.lastname: Claudepierre
authors.forename: Mathieu
authors.initials: M
authors.lastname: Luc
authors.forename: Corinne
authors.initials: C
authors.lastname: Miceli-Richard
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.forename: Michel
authors.initials: M
authors.lastname: de Bandt
authors.forename: Maxime
authors.initials: M
authors.lastname: Breban
authors.forename: Philippe
authors.initials: P
authors.lastname: Goupille
authors.forename: Jean-Francis
authors.initials: JF
authors.lastname: Maillefert
authors.forename: Charles
authors.initials: C
authors.lastname: Masson
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.forename: Thierry
authors.initials: T
authors.lastname: Schaeverbeke
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.forename: Xavier
authors.initials: X
authors.lastname: Mariette
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
mesh_terms: 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*
chemical_list: D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha