title: American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis.
abstract: OBJECTIVE
  To provide evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).
  
  
  METHODS
  A core group led the development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946-2014), PubMed (1966-2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework.
  
  
  RESULTS
  In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS.
  
  
  CONCLUSIONS
  These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas.
authors.affiliation: National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Ward
authors.affiliation: Oregon Health & Science University, Portland.
authors.forename: Atul
authors.initials: A
authors.lastname: Deodhar
authors.affiliation: American University of Beirut, Beirut, Lebanon, and McMaster University, Hamilton, Ontario, Canada.
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.affiliation: University of California, San Francisco.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lui
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Joerg
authors.initials: J
authors.lastname: Ermann
authors.affiliation: University of California, San Francisco.
authors.forename: Lianne S
authors.initials: LS
authors.lastname: Gensler
authors.affiliation: University of Wisconsin, Madison.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Smith
authors.affiliation: Arthritis and Rheumatism Associates, Washington, DC.
authors.forename: David
authors.initials: D
authors.lastname: Borenstein
authors.affiliation: Oregon Health & Science University, Portland.
authors.forename: Jayme
authors.initials: J
authors.lastname: Hiratzka
authors.affiliation: Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia.
authors.forename: Pamela F
authors.initials: PF
authors.lastname: Weiss
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Inman
authors.affiliation: University of Mississippi Medical Center, Jackson.
authors.forename: Vikas
authors.initials: V
authors.lastname: Majithia
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nigil
authors.initials: N
authors.lastname: Haroon
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Maksymowych
authors.affiliation: American College of Rheumatology, Atlanta, Georgia.
authors.forename: Janet
authors.initials: J
authors.lastname: Joyce
authors.affiliation: Vancouver, British Columbia, Canada.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Clark
authors.affiliation: National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Colbert
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Figgie
authors.affiliation: Cedars-Sinai Medical Center, Beverly Hills, California.
authors.forename: David S
authors.initials: DS
authors.lastname: Hallegua
authors.affiliation: VA Long Beach Medical Center, Long Beach, California, and University of California, Irvine.
authors.forename: Pamela E
authors.initials: PE
authors.lastname: Prete
authors.affiliation: Oregon Health & Science University and Legacy Devers Eye Institute, Portland.
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
authors.affiliation: University of Massachusetts, Worcester.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Stebulis
authors.affiliation: University of Ghent, Ghent, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Van Den Bosch
authors.affiliation: University of California, Los Angeles.
authors.forename: David T Y
authors.initials: DT
authors.lastname: Yu
authors.affiliation: American College of Rheumatology, Atlanta, Georgia.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Miller
authors.affiliation: University of Texas Health Sciences Center at Houston.
authors.forename: John D
authors.initials: JD
authors.lastname: Reveille
authors.affiliation: Denver VA Medical Center, Denver, Colorado, and University of Colorado, Aurora.
authors.forename: Liron
authors.initials: L
authors.lastname: Caplan
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D006801:Humans; D010353:Patient Education as Topic; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000188:drug therapy* / Q000534:rehabilitation
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal