The adherence to ASAS classification criteria and to ASAS recommendations for the use of anti-TNH-alpha agents in axial spondyloarthritis.
OBJECTIVE
To determine the adherence of practicing rheumatologists, before and after an educational project, to Assessment of SpondyloArthritis international Society (ASAS) classification criteria and to ASAS recommendations for the use of anti-tumor necrosis factor (TNF)-alpha agents in patients with axial spondyloarthritis (SpA).


METHODS
The project involved 53 rheumatologists attending 2 educational meetings on an update of SpA. Each meeting included interactive sessions on 1) clinical cases, 2) clinimetric evaluation, including ASAS core set for daily practice and 3) imaging. Diagnostic and therapeutic approach of each participant was tested using short clinical cases, obtained from real-life rheumatology settings, at the beginning and at the end of this educational project. Each case for diagnostic (n=10) or therapeutic purpose (n=10) had 10 possible choices. Each participant gave a score from 0 (total disagreement) to 10 (total agreement) for each choice.


RESULTS
At baseline, the rheumatologists had an excellent agreement with ASAS classification criteria for axial SpA and anti-TNF-alpha treatment according to ASAS recommendations with a further significant improvement after the educational programme. In axial SpA cases with acute anterior uveitis (AU) or Crohn's disease, anti-TNF-alpha treatment was indicated mainly as monoclonal anti-TNF antibody. In presence of elevated levels of CRP, anti-TNF option has been considered useful.


CONCLUSIONS
Practicing rheumatologists had a satisfying adherence to ASAS classification criteria and to ASAS recommendations for the use of anti-TNF-alpha agents for patients with axial SpA. Extra-articular manifestations and other variables might play a role in the decision-process of the management of axial SpA.
Dipartimento di Medicina Interna e Specialità Mediche, UOC di Reumatologia, Università "La Sapienza" di Roma, Italy.
Antonio
A
Spadaro
Ennio
E
Lubrano
Antonio
A
Marchesoni
Alberto
A
Cauli
Fabrizio
F
Cantini
Marina
M
Carotti
Salvatore
S
D'Angelo
Walter
W
Grassi
Giovanni
G
Lapadula
Pierluigi
P
Macchioni
Alessandro
A
Mathieu
Leonardo
L
Punzi
Roberta
R
Ramonda
Fausto
F
Salaffi
Carlo
C
Salvarani
Raffaele
R
Scarpa
Ignazio
I
Olivieri
D000328:Adult; D001291:Attitude of Health Personnel; D001688:Biological Products / Q000627:therapeutic use*; D017723:Drug Utilization Review; D004502:Education, Medical, Continuing; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D015397:Program Evaluation; D015203:Reproducibility of Results; D012219:Rheumatology / Q000193:education* / Q000592:standards; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism
D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha