Elsevier

Joint Bone Spine

Volume 85, Issue 3, May 2018, Pages 275-284
Joint Bone Spine

Recommendations and metaanalyses
2018 update of French Society for Rheumatology (SFR) recommendations about the everyday management of patients with spondyloarthritis

https://doi.org/10.1016/j.jbspin.2018.01.006Get rights and content

Abstract

Objective

To update French Society for Rheumatology recommendations about the management in clinical practice of patients with spondyloarthritis (SpA). SpA is considered across the range of clinical phenotypes (axial, peripheral, and entheseal) and concomitant manifestations. Psoriatic arthritis is included among the SpA phenotypes.

Methods

According to the standard procedure advocated by the EULAR for developing recommendations, we first reviewed the literature published since the previous version of the recommendations issued in June 2013. A task force used the results to develop practice guidelines, which were then revised and graded using AGREE II.

Results

Four general principles and 15 recommendations were developed. The first four recommendations deal with treatment goals and general considerations (assessment tools and comorbidities). Recommendations 5 and 6 are on non-pharmacological treatments. Recommendation 7 is about nonsteroidal anti-inflammatory drugs, which are the cornerstone of the treatment, and recommendations 8 to 10 are on analgesics, glucocorticoid therapy, and conventional disease-modifying antirheumatic drugs. Biologics are the focus of recommendations 11 through 14, which deal with newly introduced drug classes, including their indications (active disease despite conventional therapy and, for nonradiographic axial SpA, objective evidence of inflammation) and monitoring, and with patient management in the event of treatment failure or disease remission. Finally, recommendation 15 is about surgical treatments.

Conclusion

This update incorporates recent data into a smaller number of more simply formulated recommendations, with the goal of facilitating their use for guiding the management of patients with SpA.

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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    1

    These two authors contributed equally to this work.

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