Recommendations and metaanalyses2018 update of French Society for Rheumatology (SFR) recommendations about the everyday management of patients with spondyloarthritis
Introduction
Spondyloarthritis (SpA) is a complex disease that has a variety of clinical phenotypes [1], [2], [3], [4]. Patients with SpA are managed by rheumatologists, who can find guidance in various sets of recommendations. In 2013, the French Society for Rheumatology (SFR) issued recommendations for the everyday management of patients with SpA [5] and predicted that an update would be in order after a few years. This prediction has been borne out by the introduction of new drug classes and the publication of international recommendations for axial SpA [6] and psoriatic arthritis (PsA) [7], [8].
Here, our objective was to update the 2013 SFR recommendations for the everyday management of patients with SpA, in order to incorporate the new data into a smaller number of simpler recommendations.
Section snippets
Methods
This update and adaptation of the 2013 SFR recommendations was conducted in compliance with the general principles put forth in AGREE II and the standard procedure advocated by the European League against Rheumatism (EULAR), as was the case for the 2013 recommendations [5].
We started from the 2013 SFR recommendations on SpA [5], updated ASAS/EULAR recommendations for axial SpA [6], and recommendations on PsA [7], [8], with the references supporting these three sources [9], [10], [11].
Two
Scope
The updated recommendations are intended for physicians and all other healthcare professionals involved in managing patients with SpA. They apply to all adults with SpA diagnosed by a rheumatologist based on a set of arguments from the medical history, clinical examination, laboratory tests, and imaging studies. If needed, the rheumatologist may obtain additional assistance from classification criteria sets such as the Amor criteria or Assessment in Spondyloarthritis International Society
Results
Four general principles and 15 recommendations were developed. The grade of each recommendation (based on the underlying level of evidence) and the level of agreement among experts (see above) are reported for each recommendation. As with the 2013 SFR recommendation, grade A recommendations were based on level 1 evidence (meta-analysis of randomized controlled trials or at least one randomized controlled trial), grade B recommendations on level 2 evidence (at least one non randomized controlled
Discussion
These updated recommendations, while constituting a distillation of the previous version, incorporate recent data, thus providing a simpler framework composed of a substantially smaller number of recommendations. These updated recommendations cover all the SpA phenotypes, instead of focusing solely on axial disease.
The task force emphasized the importance of diagnostic certainty based on a high level of confidence of the rheumatologist that a converging set of arguments indicates SpA and that
Conclusion
This update of the recommendations issued by the French Society for Rheumatology (SFR) for the everyday management of patients with SpA is intended to assist clinicians in their daily practice and to provide practice guidelines in the field of SpA. Further updates will be required as knowledge improves and the results of ongoing studies emerge.
Funding
The Société française de rhumatologie (French Society for Rheumatology, SFR) funded the task force meetings and the publication and translation of the recommendations.
Disclosure of interest
D.W.: occasional interventions and indirect interests (accommodation expenses, grants to a non-profit organization): AbbVie, BMS, MSD, Pfizer, Roche Chugai, Amgen, Nordic, UCB, Sobi, Sanofi Aventis, Novartis, Janssen, Hospira, Celgene, Lilly, and Sandoz.
C.L.: occasional interventions and indirect interests (accommodation expenses, grants to a nonprofit organization): AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis, Pfizer, Roche Chugai, Sanofi Aventis, and UCB.
C.P.:
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2022, Joint Bone SpineCitation Excerpt :The latest classification criteria [5] have clearly increased awareness under the same SpA umbrella of clinical presentations or phenotypes – axial on one hand (radiographic and non-radiographic) and peripheral on the other [2] (articular, entheseal) – with the possibility of specific extra-articular manifestations, such as plaque psoriasis, uveitis or IBD, also being present. The French Society for Rheumatology (SFR) regularly provides recommendations for the care of patients with SpA, with the last update published in 2018 [6]. New data in the treatment of axial SpA and PsA are available along with some new indications (non-radiographic axial SpA, psoriatic arthritis).
- 1
These two authors contributed equally to this work.