title: Pharmacotherapy (excluding biotherapies) for ankylosing spondylitis: development of recommendations for clinical practice based on published evidence and expert opinion.
abstract: OBJECTIVE
  To develop recommendations about pharmacotherapy (excluding biotherapeutic agents) in patients with axial forms of ankylosing spondylitis (AS) seen in everyday clinical practice.
  
  
  METHODS
  The recommendations were based on evidence from the literature. First, a scientific committee used a Delphi procedure to select five focal points about which recommendations were needed. Then, a literature task force looked for relevant publications in the following: Cochrane, PubMed, and Ovid databases; and abstracts from the French Society for Rheumatology, European League against Rheumatism, and American College of Rheumatology. Based on the data in these publications, recommendations were drafted then validated by a group of experts. The strength of each recommendation was determined, as well as the extent of agreement among the experts.
  
  
  RESULTS
  The four focal points were the best strategy for using nonsteroidal anti-inflammatory drugs, role for systemic glucocorticoid therapy, role for glucocorticoid injections into the sacroiliac joints and entheses, and role for slow-acting drugs (e.g., methotrexate, sulfasalazine, leflunomide, thalidomide, and pamidronate). Of the 661 promising publications identified by the literature search, 173 were found to be relevant. The evidence in these 173 papers was reported to experts during interactive workshops. At the end of the workshops, the experts drafted recommendations, which were then validated by having all panel participants vote during a final meeting. There were seven recommendations, whose strength ranged from A to D.
  
  
  CONCLUSIONS
  Seven recommendations about pharmacotherapy in patients with AS were developed. They can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of patients with AS in France.
authors.affiliation: Service de Rhumatologie, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lavie
authors.forename: Stephan
authors.initials: S
authors.lastname: Pavy
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Dernis
authors.forename: Philippe
authors.initials: P
authors.lastname: Goupille
authors.forename: Alain
authors.initials: A
authors.lastname: Cantagrel
authors.forename: Jacques
authors.initials: J
authors.lastname: Tebib
authors.forename: Pascal
authors.initials: P
authors.lastname: Claudepierre
authors.forename: René Marc
authors.initials: RM
authors.lastname: Flipo
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loët
authors.forename: Jean-Francis
authors.initials: JF
authors.lastname: Maillefert
authors.forename: Xavier
authors.initials: X
authors.lastname: Mariette
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: Bernard
authors.initials: B
authors.lastname: Combe
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D032921:Consensus; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal