title: 2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis.
abstract: This paper presents the second update of the Assessment in SpondyloArthritis international Society (ASAS) consensus statement on the use of anti-tumour necrosis factor (anti-TNF) agents in patients with axial spondyloarthritis (SpA). A major change from the previous recommendations is that patients fulfilling the ASAS axial SpA criteria, which also include patients fulfilling the modified New York criteria for ankylosing spondylitis, can be treated with anti-TNF agents. This makes an earlier start in the disease process possible. A second major change is the mandatory pretreatment before anti-TNF agents can be started. All patients should have tried a minimum of two non-steroidal anti-inflammatory drugs for a minimum of 4 weeks in total. This is significantly shorter than the previous requirement of 3 months. As previously, patients with axial symptoms require no further pretreatment. Patients with symptomatic peripheral symptoms should normally have had an adequate therapeutic trial of a disease-modifying antirheumatic drug, preferably sulfasalazine. Sulfasalazine is no longer mandatory in this group of patients. Finally, efficacy should be evaluated after at least 12 weeks. The remaining recommendations stayed largely unchanged.
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. d.vanderheijde@kpnplanet.nl
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.forename: Joachim
authors.initials: J
authors.lastname: Sieper
authors.forename: Walter P
authors.initials: WP
authors.lastname: Maksymowych
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.forename: Rubén
authors.initials: R
authors.lastname: Burgos-Vargas
authors.forename: Robert
authors.initials: R
authors.lastname: Landewé
authors.forename: Martin
authors.initials: M
authors.lastname: Rudwaleit
authors.forename: Jürgen
authors.initials: J
authors.lastname: Braun
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D000075202:Contraindications; D006801:Humans; D007391:International Cooperation; D017410:Practice Guidelines as Topic; D025241:Spondylarthritis / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy*; D013167:Spondylitis, Ankylosing / Q000188:drug therapy; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha