BACKGROUND: There is ample evidence of important symptomatic efficacy of tumour necrosis factor alpha (TNFalpha) inhibition in ankylosing spondylitis (AS). Moreover, studies suggest that anti-TNF could be considered as the first disease controlling antirheumatic treatment (DC-ART) for AS. OBJECTIVE: To determine precisely which patients with AS are most likely to benefit from anti-TNFalpha treatment because of the cost and possible long term side effects of such treatment. METHODS: Assessment in Ankylosing Spondylitis (ASAS) members were asked to use a Delphi technique to name the characteristics of patients with AS for whom they would start DC-ART, in three different clinical presentations (isolated axial involvement, peripheral arthritis, enthesitis). RESULTS: Among the 62 invited ASAS members, more than 50% actively participated in the four phases of definition according to the Delphi technique. For each of the three clinical presentations, a combination of five to six domains was proposed, with an evaluation instrument and a cut off point defining a minimum level of activity for each domain. CONCLUSION: This study provides a profile for a patient with AS for considering initiation of biological agents that reflects the opinion of the ASAS members, using a Delphi exercise. Further studies are required to assess their relevance and their consistency with clinical practice.
BACKGROUND: There is ample evidence of important symptomatic efficacy of tumour necrosis factor alpha (TNFalpha) inhibition in ankylosing spondylitis (AS). Moreover, studies suggest that anti-TNF could be considered as the first disease controlling antirheumatic treatment (DC-ART) for AS. OBJECTIVE: To determine precisely which patients with AS are most likely to benefit from anti-TNFalpha treatment because of the cost and possible long term side effects of such treatment. METHODS: Assessment in Ankylosing Spondylitis (ASAS) members were asked to use a Delphi technique to name the characteristics of patients with AS for whom they would start DC-ART, in three different clinical presentations (isolated axial involvement, peripheral arthritis, enthesitis). RESULTS: Among the 62 invited ASAS members, more than 50% actively participated in the four phases of definition according to the Delphi technique. For each of the three clinical presentations, a combination of five to six domains was proposed, with an evaluation instrument and a cut off point defining a minimum level of activity for each domain. CONCLUSION: This study provides a profile for a patient with AS for considering initiation of biological agents that reflects the opinion of the ASAS members, using a Delphi exercise. Further studies are required to assess their relevance and their consistency with clinical practice.
Authors: J M Bathon; R W Martin; R M Fleischmann; J R Tesser; M H Schiff; E C Keystone; M C Genovese; M C Wasko; L W Moreland; A L Weaver; J Markenson; B K Finck Journal: N Engl J Med Date: 2000-11-30 Impact factor: 91.245
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Authors: A Boonen; A Chorus; H Miedema; D van der Heijde; H van der Tempel; S van der Linden Journal: Ann Rheum Dis Date: 2001-04 Impact factor: 19.103
Authors: J Braun; J Brandt; J Listing; A Zink; R Alten; W Golder; E Gromnica-Ihle; H Kellner; A Krause; M Schneider; H Sörensen; H Zeidler; W Thriene; J Sieper Journal: Lancet Date: 2002-04-06 Impact factor: 79.321
Authors: J Braun; T Pham; J Sieper; J Davis; Sj van der Linden; M Dougados; D van der Heijde Journal: Ann Rheum Dis Date: 2003-09 Impact factor: 19.103
Authors: D van der Heijde; J Braun; R Landewé; J Davis; J Sieper; S van der Linden; M Dougados Journal: Ann Rheum Dis Date: 2005-03 Impact factor: 19.103
Authors: A Boonen; D van der Heijde; J L Severens; A Boendermaker; R Landewé; J Braun; J Brandt; J Sieper; Sj van der Linden Journal: Ann Rheum Dis Date: 2005-07-13 Impact factor: 19.103
Authors: T Pham; R Landewé; S van der Linden; M Dougados; J Sieper; J Braun; J Davis; M Rudwaleit; E Collantes; R Burgos-Vargas; J Edmonds; I Olivieri; I van der Horst-Bruinsma; H Mielants; M Stone; P Emery; D van der Heijde Journal: Ann Rheum Dis Date: 2006-02-07 Impact factor: 19.103
Authors: Norman T Ilowite; Christy I Sandborg; Brian M Feldman; Alexi Grom; Laura E Schanberg; Edward H Giannini; Carol A Wallace; Rayfel Schneider; Kathleen Kenney; Beth Gottlieb; Philip J Hashkes; Lisa Imundo; Yukiko Kimura; Bianca Lang; Michael Miller; Diana Milojevic; Kathleen M O'Neil; Marilynn Punaro; Natasha Ruth; Nora G Singer; Richard K Vehe; James Verbsky; Amy Woodward; Lawrence Zemel Journal: Pediatr Rheumatol Online J Date: 2012-08-29 Impact factor: 3.054