[Bechterew disease--a consensus on diagnosis and treatment].
BACKGROUND
New treatment alternatives have improved the prospects for patients with ankylosing spondylitis.


METHODS
Experts from 10 countries developed and voted for 9 questions regarding diagnostics, monitoring and pharmacological treatment (except biological) of ankylosing spondylitis. The Norwegian group added two questions on non-pharmacological treatment. A thorough literature search was performed. 39 experts attended a Norwegian consensus meeting where they developed and voted for the final recommendations for treatment of ankylosing spondylitis.


RESULTS
Statements are generally based on limited evidence, but are highly supported by the experts. Important diagnostic factors are persistent inflammatory back pain in individuals under 40 years, HLA-B27-tissue, effect of NSAIDs, peripheral arthritis, morning stiffness and elevated acute phase reactants. MRI of sacroiliac joints is important for early diagnosis, but abnormalities must be verified by conventional radiographs. Long-term follow-up should include measures of inflammation, pain and function. NSAIDs and local corticosteroids are first line drugs for treatment of enthesitis. NSAIDs/coxibs are recommended as flexible on-demand-regimens. Patients should be encouraged to adapt exercising to disease severity and individual needs.


CONCLUSIONS
Consensus-based processes among experts may give valuable contributions to the management of ankylosing spondylitis.
Dagfinrud
Hanne
H
Revmatologisk avdeling Diakonhjemmet Sykehus Postboks 23 Vinderen 0319 Oslo. h.s.dagfinrud@medisin.uio.no
Heiberg
Marte Schrumpf
MS
Bakland
Gunnstein
G
Skomsvoll
Johan
J
Kvien
Tore Kristian
TK
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005500:Follow-Up Studies; D006801:Humans; D007270:Injections, Intra-Articular; D010147:Pain Measurement; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors