Abstract
Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians’ decision making, without taking out his/her autonomy when prescribing for an individual patient.
Highlights
Spondyloarthritis (SpA) is a set of diseases that cause inflammation of the spine and peripheral joints and may have extra-articular manifestations, such as anterior uveitis, psoriasis, and inflammatory bowel disease
Axial Spondyloarthritis (AxSpA) comprises the so-called radiographic form or ankylosing spondylitis (AS), which includes patients who present sacroiliitis on simple radiography according to the modified New York criteria, and non-radiographic axial spondyloarthritis, which is diagnosed according to the presence of human leukocyte antigen (HLA)-B27 or positive sacroiliac MRI, according to the 2009 Assessment in Ankylosing Spondylitis (ASAS) classification criteria [1,2,3,4]
The description of each included Randomized Clinical Trial (RCT), the risk of bias analyses, the evaluation of the quality of the evidence according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) [42, 43] and the meta-analyses with all the forest plots are available in the Supplementary Material
Summary
Spondyloarthritis (SpA) is a set of diseases that cause inflammation of the spine and peripheral joints and may have extra-articular manifestations, such as anterior uveitis, psoriasis, and inflammatory bowel disease. AxSpA comprises the so-called radiographic form or AS, which includes patients who present sacroiliitis on simple radiography according to the modified New York criteria, and non-radiographic axial spondyloarthritis (nr-axSpA), which is diagnosed according to the presence of HLA-B27 (clinical arm) or positive sacroiliac MRI (imaging arm), according to the 2009 Assessment in Ankylosing Spondylitis (ASAS) classification criteria [1,2,3,4]. The present recommendations will address axSpA as a single entity and combine all relevant data, since most of the available studies included patients with the radiographic form. Our main goal in the present guideline was to evaluate the role of NSAIDs for treating axSpA patients through a systematic review with meta-analysis and critical analysis of the published scientific data
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