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Spinal Diseases HELP
Based on 40,206 articles published since 2009
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These are the 40206 published articles about Spinal Diseases that originated from Worldwide during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Guideline 2018 APLAR axial spondyloarthritis treatment recommendations. 2019

Tam, Lai Shan / Wei, James Cheng-Chung / Aggarwal, Amita / Baek, Han Joo / Cheung, Peter P / Chiowchanwisawakit, Praveena / Dans, Leonila / Gu, Jieruo / Hagino, Noboru / Kishimoto, Mitsumasa / Reyes, Heizel Manapat / Soroosh, Soosan / Stebbings, Simon / Whittle, Samuel / Yeap, Swan Sim / Lau, Chak Sing. ·Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong. · Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. · Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan. · Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan. · Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. · Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea. · Division of Rheumatology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore. · Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. · Department of Pediatrics and Clinical Epidemiology, Philippine General Hospital, University of the Philippines, Manila, Philippines. · Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. · Division of Hematology and Rheumatology, Teikyo University Chiba Medical Center, Chiba, Japan. · Immuno-Rheumatology Center, St Luke`s International Hospital, St Luke`s International University, Tokyo, Japan. · Division of Rheumatology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines. · AJA University of Medical Sciences, Rheumatology Research Center, Tehran, Iran. · Department of Medicine Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. · The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia. · Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Malaysia. · Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong. ·Int J Rheum Dis · Pubmed #30816645.

ABSTRACT: INTRODUCTION: Despite the availability of axial spondyloarthritis (SpA) recommendations proposed by various rheumatology societies, we considered that a region-specific guideline was of substantial added value to clinicians of the Asia-Pacific region, given the wide variations in predisposition to infections and other patient factors, local practice patterns, and access to treatment across countries. MATERIALS AND METHODS: Systematic reviews were undertaken of English-language articles published between 2000 and 2016, identified from MEDLINE using PubMed, EMBASE and Cochrane databases. The strength of available evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Recommendations were developed through consensus using the Delphi technique. RESULTS: Fourteen axial SpA treatment recommendations were developed based on evidence summaries and consensus. The first 2 recommendations cover non-pharmacological approaches to management. Recommendations 3 to 5 describe the following: the use of non-steroidal anti-inflammatory drugs as first-line symptomatic treatment; the avoidance of long-term corticosteroid use; and the utility of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) for peripheral or extra-articular manifestations. Recommendation 6 refers to the indications for biological DMARDs (bDMARDs). Recommendation 7 deals specifically with screening for infections endemic to Asia, prior to use of bDMARDs. Recommendations 7 to 13 cover the role of bDMARDs in the treatment of active axial SpA and include related issues such as continuing therapy and use in special populations. Recommendation 14 deals with the utility of surgical intervention in axial SpA. CONCLUSION: These recommendations provide up-to-date guidance for treatment of axial SpA to help meet the needs of patients and clinicians in the Asia-Pacific region.

2 Guideline Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. 2019

Elmets, Craig A / Leonardi, Craig L / Davis, Dawn M R / Gelfand, Joel M / Lichten, Jason / Mehta, Nehal N / Armstrong, April W / Connor, Cody / Cordoro, Kelly M / Elewski, Boni E / Gordon, Kenneth B / Gottlieb, Alice B / Kaplan, Daniel H / Kavanaugh, Arthur / Kivelevitch, Dario / Kiselica, Matthew / Korman, Neil J / Kroshinsky, Daniela / Lebwohl, Mark / Lim, Henry W / Paller, Amy S / Parra, Sylvia L / Pathy, Arun L / Prater, Elizabeth Farley / Rupani, Reena / Siegel, Michael / Stoff, Benjamin / Strober, Bruce E / Wong, Emily B / Wu, Jashin J / Hariharan, Vidhya / Menter, Alan. ·University of Alabama, Birmingham, Alabama. · Central Dermatology, St. Louis, Missouri. · Mayo Clinic, Rochester, Minnesota. · University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · National Psoriasis Foundation, Portland, Oregon. · National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. · University of Southern California, Los Angeles, California. · Department of Dermatology, University of California San Francisco School of MedicineSan Francisco, California. · Medical College of Wisconsin, Milwaukee, Wisconsin. · Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York. · University of Pittsburgh, Pennsylvania. · University of California San Diego, San Diego, California. · Baylor Scott and White, Dallas, Texas. · University Hospitals Cleveland Medical Center, Cleveland, Ohio. · Massachusetts General Hospital, Boston, Massachusetts. · Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Dermatology and Skin Surgery, Sumter, South Carolina. · Colorado Permanente Medical Group, Centennial, Colorado. · University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. · Icahn School of Medicine at Mount Sinai, New York, New York. · Emory University School of Medicine, Atlanta, Georgia. · University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Canada. · San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas. · Dermatology Research and Education Foundation, Irvine, California. · American Academy of Dermatology, Rosemont, Illinois. Electronic address: vhariharan@aad.org. ·J Am Acad Dermatol · Pubmed #30772097.

ABSTRACT: Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.

3 Guideline The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment. 2019

Deer, Timothy R / Grider, Jay S / Pope, Jason E / Falowski, Steven / Lamer, Tim J / Calodney, Aaron / Provenzano, David A / Sayed, Dawood / Lee, Eric / Wahezi, Sayed E / Kim, Chong / Hunter, Corey / Gupta, Mayank / Benyamin, Rasmin / Chopko, Bohdan / Demesmin, Didier / Diwan, Sudhir / Gharibo, Christopher / Kapural, Leo / Kloth, David / Klagges, Brian D / Harned, Michael / Simopoulos, Tom / McJunkin, Tory / Carlson, Jonathan D / Rosenquist, Richard W / Lubenow, Timothy R / Mekhail, Nagy. ·Center for Pain Relief, Charleston, West Virginia, U.S.A. · UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A. · Evolve Restorative Clinic, Santa Rosa, California, U.S.A. · Functional Neurosurgery, St. Lukes University Health Network, Bethlehem, Pennsylvania, U.S.A. · Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A. · Texas Spine and Joint Hospital, Tyler, Texas, U.S.A. · Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, U.S.A. · University of Kansas Medical Center, Kansas City, Kansas, U.S.A. · Summit Pain Alliance, Sonoma, California, U.S.A. · Montefiore Medical Center, SUNY-Buffalo, Buffalo, New York, U.S.A. · Ainsworth Institute of Pain Management, New York, New York, U.S.A. · Anesthesiology and Pain Medicine, HCA Midwest Health, Overland Park, Kansas, U.S.A. · Millennium Pain Center, Bloomington, Illinois, U.S.A. · College of Medicine, University of Illinois, Urbana-Champaign, Illinois, U.S.A. · Stanford Health Care, Henderson, Nevada, U.S.A. · Rutgers Robert Wood Johnson Medical School, Department of Pain Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, U.S.A. · Manhattan Spine and Pain Medicine, Lenox Hill Hospital, New York, New York, U.S.A. · Pain Medicine and Orthopedics, NYU Langone Hospitals Center, New York, New York, U.S.A. · Carolina's Pain Institute at Brookstown, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A. · Department of Anesthesiology, Danbury Hospital, Danbury, Connecticut, U.S.A. · Anesthesiology and Pain Medicine, Amoskeag Anesthesiology, Manchester, New Hampshire, U.S.A. · Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, U.S.A. · Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A. · Pain Doctor Inc., Phoenix, Arizona, U.S.A. · Arizona Pain, Midwestern Medical School, Glendale, Arizona, U.S.A. · Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A. · Rush University Medical Center, Chicago, Illinois, U.S.A. · Evidence-Based Pain Management Research and Education, Cleveland Clinic, Cleveland, Ohio, U.S.A. ·Pain Pract · Pubmed #30369003.

ABSTRACT: BACKGROUND: Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. METHODS: The Lumbar Spinal Stenosis Consensus Group convened to evaluate the peer-reviewed literature as the basis for making minimally invasive spine treatment (MIST) recommendations. Eleven consensus points were clearly defined with evidence strength, recommendation grade, and consensus level using U.S. Preventive Services Task Force criteria. The Consensus Group also created a treatment algorithm. Literature searches yielded 9 studies (2 randomized controlled trials [RCTs]; 7 observational studies, 4 prospective and 3 retrospective) of minimally invasive spine treatments, and 1 RCT for spacers. RESULTS: The LSS treatment choice is dependent on the degree of stenosis; spinal or anatomic level; architecture of the stenosis; severity of the symptoms; failed, past, less invasive treatments; previous fusions or other open surgical approaches; and patient comorbidities. There is Level I evidence for percutaneous image-guided lumbar decompression as superior to lumbar epidural steroid injection, and 1 RCT supported spacer use in a noninferiority study comparing 2 spacer products currently available. CONCLUSIONS: MISTs should be used in a judicious and algorithmic fashion to treat LSS, based on the evidence of efficacy and safety in the peer-reviewed literature. The MIST Consensus Group recommend that these procedures be used in a multimodal fashion as part of an evidence-based decision algorithm.

4 Guideline Lumbar herniated disc treatment with percutaneous hydrodiscectomy. 2018

Anonymous3681096 / Silvinato, Antonio / Simões, Ricardo S / Buzzini, Renata F / Bernardo, Wanderley M. ·. Member of the Guidelines Program of the Brazilian Medical Association, São Paulo, SP, Brasil. · . Lecturer Professor of School of Medicine of USP; São Paulo, SP, Brasil. · . Coordinator of the Brazilian Medical Association Guidelines Program, São Paulo, SP, Brasil. ·Rev Assoc Med Bras (1992) · Pubmed #30672996.

ABSTRACT: Lumbar herniated disc are common manifestations of degenerative spine diseases, the main cause of radiated lower back pain. This guideline followed standard of a systematic review with recovery of evidence based on the movement of evidence-based medicine. We used the structured method for formulating the question synthesized by the acronym p.I.C.O., In which the p corresponds to the lumbar herniated disc, i to the treatment intervention with percutaneous hydrodiscectomy, c comparing with other treatment modalities, o the outcome of clinical evolution and complications. From the structured question, we identify the descriptors which constituted the evidence search base in the medline-pubmed databases (636 papers) and therefore, after the eligibility criteria (inclusion and exclusion), eight papers were selected to answer to clinical question. The details of the methodology and the results of this guideline are exposed in annex i.

5 Guideline Lumbar herniated disc - endoscopic discectomy treatment. 2018

Joaquim, Andrei Fernandes / Botelho, Ricardo Vieira / Mudo, Marcelo Luis / Almeida, Antonio Silvinato de / Bernardo, Wanderley Marques. ·Brazilian Society of Neurosurgery, São Paulo, SP, Brasil. · Brazilian Medical Association, São Paulo, SP, Brasil. ·Rev Assoc Med Bras (1992) · Pubmed #30304136.

ABSTRACT: The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

6 Guideline 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. 2018

Rausch Osthoff, Anne-Kathrin / Niedermann, Karin / Braun, Jürgen / Adams, Jo / Brodin, Nina / Dagfinrud, Hanne / Duruoz, Tuncay / Esbensen, Bente Appel / Günther, Klaus-Peter / Hurkmans, Emailie / Juhl, Carsten Bogh / Kennedy, Norelee / Kiltz, Uta / Knittle, Keegan / Nurmohamed, Michael / Pais, Sandra / Severijns, Guy / Swinnen, Thijs Willem / Pitsillidou, Irene A / Warburton, Louise / Yankov, Zhivko / Vliet Vlieland, Theodora P M. ·School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland. · Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands. · Rheumazentrum Ruhrgebiet, Herne, Germany. · Ruhr University, Bochum, Germany. · Faculty of Health Sciences and Arthritis Research UK Centre of Excellence for Sport, Exercise and Osteoarthritis, University of Southampton, Southampton, UK. · Department of Orthopaedics, Danderyd University Hospital Corp., Stockholm, Sweden. · Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden. · National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · PMR Department, Rheumatology Division, Marmara University, School of Medicine, Istanbul, Turkey. · Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet., Glostrup, Denmark. · Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. · University Center of Orthopaedics and Traumatology, University Medicine at Technische Universität Dresden, Dresden, Germany. · Department Social Affaire and Health, ECORYS Nederland BV, Rotterdam, Netherlands. · Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. · Departmentof Occupational and Physical Therapy, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark. · School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland. · Department of Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland. · Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, The Netherlands. · Centre for Biomedical Research, University of Algarve, Faro, Portugal. · EULAR PARE Patient Research Partner, ReumaNet, Leuven, Belgium. · Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium. · Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium. · EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus. · Primary Health Care Sciences, Keele University, Keele, UK. · PRP (Patient Research Partner EULAR), Bulgarian Ankylosing Spondylitis Patient Society, Sofia, Bulgaria and ASIF (Ankylosing Spondylitis International Federation), London, UK. ·Ann Rheum Dis · Pubmed #29997112.

ABSTRACT: Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.

7 Guideline Recommendations of the Spanish Society of Rheumatology on treatment and use of systemic biological and non-biological therapies in psoriatic arthritis. 2018

Torre Alonso, Juan Carlos / Díaz Del Campo Fontecha, Petra / Almodóvar, Raquel / Cañete, Juan D / Montilla Morales, Carlos / Moreno, Mireia / Plasencia-Rodríguez, Chamaida / Ramírez García, Julio / Queiro, Rubén. ·Unidad de Reumatología, Hospital Monte Naranco y Universidad de Oviedo, Oviedo, España. · Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España. · Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España. · Unidad de Artritis, Servicio de Reumatología, Hospital Clínic, Barcelona, España. · Servicio de Reumatología, Hospital Clínico Universitario de Salamanca, Salamanca, España. · Servicio de Reumatología, Parc Taulí Hospital Universitari, Sabadell, Barcelona, España. · Servicio de Reumatología, Hospital Universitario La Paz, IdiPaz, Madrid, España. · Unidad de Artritis, Servicio de Reumatología, IDIBAPS y Hospital Clínic, Barcelona, España. · Sección de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España. Electronic address: rubenque7@yahoo.es. ·Reumatol Clin · Pubmed #29111261.

ABSTRACT: OBJECTIVE: The main purpose of this recommendation statement is to provide clinicians with the best available evidence and the best opinion agreed upon by the panelists for a rational use of synthetic disease modifying antirheumatic drugs (DMARDs) and biologicals in psoriatic arthritis (PsA) patients. The present document also focuses on important aspects in the management of PsA, such as early diagnosis, therapeutic objectives, comorbidities and optimization of treatment. METHODS: The recommendations were agreed by consensus by a panel of 8 expert rheumatologists, previously selected by the Spanish Society of Rheumatology (SER) through an open call. The phases of the work were: identification of key areas for updating the previous consensus, analysis and synthesis of scientific evidence (modified Oxford system, Centre for Evidence-based Medicine, 2009) and formulation of recommendations based on this evidence and by consensus techniques. RESULTS: Seventeen recommendations were issued for the treatment of PsA patients. Six of them were of general nature, ranging from the early diagnosis and treatment to the importance of assessing comorbidities. The other 11 were focused on the indications for DMARDs and biological therapy in the distinct clinical forms of the disease. Likewise, the situation of failure of the first biological is addressed and treatment algorithms and a table with the different biological therapies are also included. CONCLUSIONS: We present the update of SER recommendations for the treatment of PsA with DMARDs and biologics.

8 Guideline Recommendations by the Spanish Society of Rheumatology on the Use of Biological Therapies in Axial Spondyloarthritis. 2018

Gratacós, Jordi / Díaz Del Campo Fontecha, Petra / Fernández-Carballido, Cristina / Juanola Roura, Xavier / Linares Ferrando, Luis Francisco / de Miguel Mendieta, Eugenio / Muñoz Fernández, Santiago / Rosales-Alexander, Jose Luis / Zarco Montejo, Pedro / Guerra Rodríguez, Mercedes / Navarro Compán, Victoria. ·Servicio de Reumatología, Hospital Universitario Parc Taulí, I3PT, UAB, Sabadell, Barcelona, España. Electronic address: jgratacosmas@gmail.com. · Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España. · Servicio de Reumatología, Hospital General Universitario de Elda, Elda, Alicante, España. · Servicio de Reumatología, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Barcelona, España. · Servicio de Reumatología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España. · Servicio de Reumatología, Hospital Universitario La Paz, IdiPaz, Madrid, España. · Servicio de Reumatología, Hospital Universitario Infanta Sofía, Universidad Europea, San Sebastián de los Reyes, Madrid, España. · Servicio de Reumatología, Hospiten Rambla, Santa Cruz de Tenerife, España. · Servicio de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España. ·Reumatol Clin · Pubmed #29050839.

ABSTRACT: OBJECTIVE: Recent data published on biological therapy in axial spondyloarthritis (axSpA) since the last publication of the recommendations of the Spanish Society of Rheumatology (SER) has led to the generation of a review of these recommendations based on the best possible evidence. These recommendations should be a reference for rheumatologists and those involved in the treatment of patients with axSpA. METHODS: Recommendations were drawn up following a nominal group methodology and based on systematic reviews. The level of evidence and grade of recommendation were classified according to the model proposed by the Centre for Evidence Based Medicine at Oxford. The level of agreement was established through the Delphi technique. RESULTS: In this review, we did an update of the evaluation of disease activity and treatment objectives. We included the new drugs with approved therapeutic indication for axSpA. We reviewed both the predictive factors of the therapeutic response and progression of radiographic damage. Finally, we drafted some recommendations for the treatment of patients refractory to anti-tumor necrosis factor, as well as for the possible optimization of biological therapy. The document also includes a table of recommendations and a treatment algorithm. CONCLUSIONS: We present an update of the SER recommendations for the use of biological therapy in patients with axSpA.

9 Guideline Screening of Inflammatory Bowel Disease and Spondyloarthritis for Referring Patients Between Rheumatology and Gastroenterology. 2018

Sanz Sanz, Jesús / Juanola Roura, Xavier / Seoane-Mato, Daniel / Montoro, Miguel / Gomollón, Fernando / Anonymous3000915. ·Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España. Electronic address: jesussanzsanz4@gmail.com. · Servicio de Reumatología, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España. · Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España. · Unidad de Gastroenterología y Hepatología, Hospital General San Jorge, Huesca, España. · Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo. Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España. ·Reumatol Clin · Pubmed #28784316.

ABSTRACT: OBJECTIVE: To define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for referring them to the rheumatology or gastroenterology service. METHOD: Systematic literature review and a two-round Delphi method. The scientific committee and the expert panel were comprised of 2 rheumatologists and 2 gastroenterologists, and 7 rheumatologists and 7 gastroenterologists, respectively. The scientific committee defined the initial version of the criteria, taking into account sensitivity, specificity, standardization and ease of application. Afterwards, members of the expert panel assessed each item in a two-round Delphi survey. Items that met agreement in the first or second round were included in the final version of the criteria. RESULTS: Positive screening for SpA if at least one of the following is present: onset of chronic low back pain before 45 years of age; inflammatory low back pain or alternating buttock pain; HLA-B27 positivity; sacroiliitis on imaging; arthritis; heel enthesitis; dactylitis. Positive screening for IBD in the presence of one of the major criteria or at least two minor criteria. Major: rectal bleeding; chronic diarrhea with organic characteristics; perianal disease. Minor: chronic abdominal pain; iron deficiency anemia or iron deficiency; extraintestinal manifestations; fever or low grade fever, of unknown origin and duration >1week; unexplained weight loss; family history of IBD. CONCLUSION: Screening criteria for IBD in patients with SpA, and vice versa, have been developed. These criteria will be useful for early detection of both diseases.

10 Guideline Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. 2018

Smolen, Josef S / Schöls, Monika / Braun, Jürgen / Dougados, Maxime / FitzGerald, Oliver / Gladman, Dafna D / Kavanaugh, Arthur / Landewé, Robert / Mease, Philip / Sieper, Joachim / Stamm, Tanja / Wit, Maarten de / Aletaha, Daniel / Baraliakos, Xenofon / Betteridge, Neil / Bosch, Filip van den / Coates, Laura C / Emery, Paul / Gensler, Lianne S / Gossec, Laure / Helliwell, Philip / Jongkees, Merryn / Kvien, Tore K / Inman, Robert D / McInnes, Iain B / Maccarone, Mara / Machado, Pedro M / Molto, Anna / Ogdie, Alexis / Poddubnyy, Denis / Ritchlin, Christopher / Rudwaleit, Martin / Tanew, Adrian / Thio, Bing / Veale, Douglas / Vlam, Kurt de / van der Heijde, Désirée. ·Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria. · 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria. · Health Consult, Vienna, Austria. · Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany. · Department of Rheumatology, Paris Descartes University, Paris, France. · Department of Rheumatology, St Vincent's University Hospital, Dublin, Ireland. · Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada. · Division of Rheumatology, University of California, San Diego, CA, USA. · Amsterdam Rheumatology & Immunology Center, Amsterdam, The Netherlands. · Division of Rheumatology Research, Swedish-Providence St. Joseph Health System, University of Washington, Seattle, WA, USA. · Department of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany. · Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria. · Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands. · Neil Betteridge Associates, UK. · Ghent University Hospital, Ghent, Belgium. · Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK. · Department of Medicine, University of California, San Francisco, CA, USA. · Department of Rheumatology, UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS); AP-HP, Pitié Salpêtrière Hospital, Paris, France. · Institute of Molecular Medicine, University of Leeds, Leeds, UK. · Seayn Medical, Voorschoten, The Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · University Health Network and University of Toronto, Toronto, Ontario, Canada. · University of Glasgow, College of Medical Veterinary and Life Sciences, Glasgow, UK. · A.DI.PSO. (Associazione per la Difesa degli Psoriasici)-PE.Pso.POF (Pan European Psoriasis Patients' Organization Forum), Rome, Italy. · Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK. · Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA. · German Rheumatism Research Centrer, Berlin, Germany. · Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center Rochester, New York, NY, USA. · Division of Internal Medicine and Rheumatology, Klinikum Bielefeld, Bielefeld, Germany. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. · Department of Dermatology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands. · Department of Rheumatology, Klinikum Bielefeld, Bielefeld, Germany. · Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium. · Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. ·Ann Rheum Dis · Pubmed #28684559.

ABSTRACT: Therapeutic targets have been defined for axial and peripheral spondyloarthritis (SpA) in 2012, but the evidence for these recommendations was only of indirect nature. These recommendations were re-evaluated in light of new insights. Based on the results of a systematic literature review and expert opinion, a task force of rheumatologists, dermatologists, patients and a health professional developed an update of the 2012 recommendations. These underwent intensive discussions, on site voting and subsequent anonymous electronic voting on levels of agreement with each item. A set of 5 overarching principles and 11 recommendations were developed and voted on. Some items were present in the previous recommendations, while others were significantly changed or newly formulated. The 2017 task force arrived at a single set of recommendations for axial and peripheral SpA, including psoriatic arthritis (PsA). The most exhaustive discussions related to whether PsA should be assessed using unidimensional composite scores for its different domains or multidimensional scores that comprise multiple domains. This question was not resolved and constitutes an important research agenda. There was broad agreement, now better supported by data than in 2012, that remission/inactive disease and, alternatively, low/minimal disease activity are the principal targets for the treatment of PsA. As instruments to assess the patients on the path to the target, the Ankylosing Spondylitis Disease Activity Score (ASDAS) for axial SpA and the Disease Activity index for PSoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA) for PsA were recommended, although not supported by all. Shared decision-making between the clinician and the patient was seen as pivotal to the process. The task force defined the treatment target for SpA as remission or low disease activity and developed a large research agenda to further advance the field.

11 Guideline Recommendations for the Use of Ultrasound and Magnetic Resonance in Patients With Spondyloarthritis, Including Psoriatic Arthritis, and Patients With Juvenile Idiopathic Arthritis. 2018

Uson, Jacqueline / Loza, Estibaliz / Möller, Ingrid / Acebes, Carlos / Andreu, Jose Luis / Batlle, Enrique / Bueno, Ángel / Collado, Paz / Fernández-Gallardo, Juan Manuel / González, Carlos / Jiménez Palop, Mercedes / Lisbona, María Pilar / Macarrón, Pilar / Maymó, Joan / Narváez, Jose Antonio / Navarro-Compán, Victoria / Sanz, Jesús / Rosario, M Piedad / Vicente, Esther / Naredo, Esperanza. ·Servicio de Reumatología, Hospital Universitario de Móstoles, Móstoles, Madrid, España. · Instituto de Salud Musculoesquelética, Madrid, España. Electronic address: estibaliz.loza@inmusc.eu. · Servicio de Reumatología, Instituto Poal de Reumatología, Barcelona, España. · Servicio de Reumatología, Hospital General de Villalba, Collado Villalba, Madrid, España. · Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España. · Servicio de Reumatología, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España. · Servicio de Radiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España. · Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España. · Servicio de Radiología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España. · Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España. · Servicio de Reumatología, Hospital del Mar, Barcelona, España. · Servicio de Reumatología, Hospital Universitario Clínico San Carlos, Madrid, España. · Servicio de Radiodiagnóstico, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. · Servicio de Reumatología, Hospital Universitario La Paz, IdiPAZ, Madrid, España. · Servicio Andaluz de Salud, Sevilla, España. · Servicio de Reumatología, Hospital Universitario de La Princesa, Madrid, España. ·Reumatol Clin · Pubmed #28277255.

ABSTRACT: OBJECTIVE: To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging in patients with spondyloarthritis, including psoriatic arthritis, and juvenile idiopathic arthritis. METHODS: Recommendations were generated following a nominal group technique. A panel of experts (15 rheumatologists and 3 radiologists) was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of participants voted≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. RESULTS: A total of 12 recommendations were proposed for each disease. They include, along with explanations of the validity of US and magnetic resonance imaging regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. CONCLUSIONS: These recommendations will help clinicians use US and magnetic resonance imaging in patients with spondyloarthritis and juvenile idiopathic arthritis.

12 Guideline Spondyloarthritis: NICE Releases Guidelines on Diagnosis and Treatment. 2017

Hauk, Lisa. · ·Am Fam Physician · Pubmed #29431390.

ABSTRACT: -- No abstract --

13 Guideline Portuguese recommendations for the use of biological therapies in patients with axial spondyloarthritis - 2016 update. 2017

Machado, Pedro / Cerqueira, Marcos / Ávila-Ribeiro, Pedro / Aguiar, Renata / Bernardo, Alexandra / Sepriano, Alexandre / Águeda, Ana / Cordeiro, Ana / Raposo, Ana / Rodrigues, Ana M / Barcelos, Anabela / Malcata, Armando / Lopes, Carina / Vaz, Cláudia C / Nour, Dolores / Godinho, Fátima / Alvarenga, Fernando / Pimentel-Santos, Fernando / Canhão, Helena / Santos, Helena / Cunha, Inês / Neves, Joana Sousa / Fonseca, João Eurico / Gomes, João Lagoas / Tavares-Costa, José / Costa, Lúcia / Cunha-Miranda, Luís / Maurício, Luís / Cruz, Margarida / Afonso, Maria Carmo / Santos, Maria José / Bernardes, Miguel / Valente, Paula / Figueira, Ricardo / Pimenta, Sofia / Ramiro, Sofia / Pedrosa, Teresa / Costa, Tiago Afonso / Vieira-Sousa, Elsa. ·University College London, London, UK. · Rheumatology Department, Unidade Local de Saúde do Alto Minho, Hospital Conde de Bertiandos, Ponte de Lima, Portugal. · Rheumatology and Metabolic Bone Diseases Department, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal. · Rheumatology Department, Centro Hospitalar do Baixo Vouga, Hospital de Aveiro, Aveiro, Portugal. · Rheumatology Department, Centro Hospitalar de S. João, Porto, Portugal. · NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal. · Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal. · Rheumatology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal. · CEDOC, EpiDoC Unit, NOVA Medical School and National School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal. · Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. · CEDOC, EpiDoC Unit, NOVA Medical School and National School of Public Health, Universidade Nova de Lisboa; Rheumatology Department, Centro Hospitalar Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Portugal. · Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal. · Clínica Intregare Terapêutica - Fortaleza: Clínica da Família, Fortaleza, Brasil. · Consultório Privado de Reumatologia, Portugal. · Instituto Português de Reumatologia, Lisboa, Portugal. · Rheumatology and Metabolic Bone Diseases Department, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon Academic Medical Centre, Lisbon, P. · Rheumatology Department, Centro Hospitalar Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Portugal. · Centro Hospitalar de Entre o Douro e Vouga, Hospital de São Sebastião, Santa Maria da Feira, Portugal. · Centro Hospitalar do Funchal, Funchal, Madeira, Portugal. · NOVA Medical School, Universidade Nova de Lisboa; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. ·Acta Reumatol Port · Pubmed #28894079.

ABSTRACT: OBJECTIVE: To update the recommendations for the treatment of axial spondyloarthritis (axSpA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. At a national meeting, the 7 recommendations included in this document were discussed and updated. A draft of the full text of the recommendations was then circulated and suggestions were incorporated. A final version was again circulated before publication and the level of agreement among Portuguese Rheumatologists was anonymously assessed using an online survey. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching of biological therapies in patients with axSpA. In total, seven recommendations were produced. The first recommendation is a general statement indicating that biological therapy is not a first-line drug treatment option and should only be used after conventional treatment has failed. The second recommendation is also a general statement about the broad concept of axSpA adopted by these recommendations that includes both non-radiographic and radiographic axSpA. Recommendations 3 to 7 deal with the definition of active disease (including the recommended threshold of 2.1 for the Ankylosing Spondylitis Disease Activity Score [ASDAS] or the threshold of 4 [0-10 scale] for the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), conventional treatment failure (nonsteroidal anti-inflammatory drugs being the first-line drug treatment), assessment of response to treatment (based on an ASDAS improvement  of at least 1.1 units or a BASDAI improvement of at least 2 units [0-10 scale] or at least 50%), and strategy in the presence of an inadequate response (where switching is recommended) or in the presence of long-term remission (where a process of biological therapy optimization can be considered, either a gradual increase in the interval between doses or a decrease of each dose of the biological therapy). CONCLUSION: These recommendations may be used for guidance in deciding which patients with axSpA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.

14 Guideline Reirradiation spine stereotactic body radiation therapy for spinal metastases: systematic review. 2017

Myrehaug, Sten / Sahgal, Arjun / Hayashi, Motohiro / Levivier, Marc / Ma, Lijun / Martinez, Roberto / Paddick, Ian / Régis, Jean / Ryu, Samuel / Slotman, Ben / De Salles, Antonio. ·Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada. · Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan. · Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. · Division of Physics, Department of Radiation Oncology, University of California, San Francisco, California. · Department Neurosurgery, Ruber Internacional Hospital, Madrid, Spain. · National Hospital for Neurology & Neurosurgery, University College London, United Kingdom. · Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France. · Department of Radiation Oncology and Neurosurgery, Stony Brook University, Stony Brook, New York. · Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; and. · Department of Neurosurgery, University of California, Los Angeles, California, and HCor Neuroscience, São Paulo, Brazil. ·J Neurosurg Spine · Pubmed #28708043.

ABSTRACT: OBJECTIVE Spinal metastases that recur after conventional palliative radiotherapy have historically been difficult to manage due to concerns of spinal cord toxicity in the retreatment setting. Spine stereotactic body radiation therapy (SBRT), also known as stereotactic radiosurgery, is emerging as an effective and safe means of delivering ablative doses to these recurrent tumors. The authors performed a systematic review of the literature to determine the clinical efficacy and safety of spine SBRT specific to previously irradiated spinal metastases. METHODS A systematic literature review was conducted, which was specific to SBRT to the spine, using MEDLINE, Embase, Cochrane Evidence-Based Medicine Database, National Guideline Clearinghouse, and CMA Infobase, with further bibliographic review of appropriate articles. Research questions included: 1) Is retreatment spine SBRT efficacious with respect to local control and symptom control? 2) Is retreatment spine SBRT safe? RESULTS The initial literature search retrieved 2263 articles. Of these articles, 160 were potentially relevant, 105 were selected for in-depth review, and 9 studies met all inclusion criteria for analysis. All studies were single-institution series, including 4 retrospective, 3 retrospective series of prospective databases, 1 prospective, and 1 Phase I/II prospective study (low- or very low-quality data). The results indicated that spine SBRT is effective, with a median 1-year local control rate of 76% (range 66%-90%). Improvement in patients' pain scores post-SBRT ranged from 65% to 81%. Treatment delivery was safe, with crude rates of vertebral body fracture of 12% (range 0%-22%) and radiation-induced myelopathy of 1.2%. CONCLUSIONS This systematic literature review suggests that SBRT to previously irradiated spinal metastases is safe and effective with respect to both local control and pain relief. Although the evidence is limited to low-quality data, SBRT can be a recommended treatment option for reirradiation.

15 Guideline 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. 2017

Goodman, Susan M / Springer, Bryan / Guyatt, Gordon / Abdel, Matthew P / Dasa, Vinod / George, Michael / Gewurz-Singer, Ora / Giles, Jon T / Johnson, Beverly / Lee, Steve / Mandl, Lisa A / Mont, Michael A / Sculco, Peter / Sporer, Scott / Stryker, Louis / Turgunbaev, Marat / Brause, Barry / Chen, Antonia F / Gililland, Jeremy / Goodman, Mark / Hurley-Rosenblatt, Arlene / Kirou, Kyriakos / Losina, Elena / MacKenzie, Ronald / Michaud, Kaleb / Mikuls, Ted / Russell, Linda / Sah, Alexander / Miller, Amy S / Singh, Jasvinder A / Yates, Adolph. ·Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York. Electronic address: goodmans@hss.edu. · Bryan Springer, MD: OrthoCarolina Hip and Knee Center, Charlotte, North Carolina. · Gordon Guyatt, MD: McMaster University, Hamilton, Ontario, Canada. · Matthew P. Abdel, MD: Mayo Clinic, Rochester, Minnesota. · Vinod Dasa, MD: Louisiana State University, New Orleans. · Michael George, MD: University of Pennsylvania, Philadelphia. · Ora Gewurz-Singer, MD: University of Michigan, Ann Arbor. · Jon T. Giles, MD, MPH: Columbia University, New York, New York. · Beverly Johnson, MD: Albert Einstein College of Medicine, Bronx, New York. · Steve Lee, DO: Kaiser Permanente, Fontana, California. · Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York. · Michael A. Mont, MD: Cleveland Clinic, Cleveland, Ohio. · Scott Sporer, MD: Midwest Orthopaedics at Rush, Chicago, Illinois. · Louis Stryker, MD: University of Texas Medical Branch, Galveston. · Marat Turgunbaev, MD, MPH, Amy S. Miller: American College of Rheumatology, Atlanta, Georgia. · Antonia F. Chen, MD, MBA: Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. · Jeremy Gililland, MD: University of Utah, Salt Lake City. · Mark Goodman, MD, Adolph Yates, MD: University of Pittsburgh, Pittsburgh, Pennsylvania. · Arlene Hurley-Rosenblatt, ANP: Rockefeller University, New York, New York. · Elena Losina, PhD: Brigham and Women's Hospital, Boston, Massachusetts. · Kaleb Michaud, PhD: National Data Bank for Rheumatic Diseases, Wichita, Kansas and University of Nebraska Medical Center, Omaha. · Ted Mikuls, MD, MSPH: University of Nebraska Medical Center, Omaha. · Alexander Sah, MD: Dearborn-Sah Institute for Joint Restoration, Fremont, California. · Jasvinder A. Singh, MBBS, MPH: University of Alabama at Birmingham. ·J Arthroplasty · Pubmed #28629905.

ABSTRACT: OBJECTIVE: This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). METHODS: A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. RESULTS: The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence. CONCLUSION: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.

16 Guideline 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. 2017

Goodman, Susan M / Springer, Bryan / Guyatt, Gordon / Abdel, Matthew P / Dasa, Vinod / George, Michael / Gewurz-Singer, Ora / Giles, Jon T / Johnson, Beverly / Lee, Steve / Mandl, Lisa A / Mont, Michael A / Sculco, Peter / Sporer, Scott / Stryker, Louis / Turgunbaev, Marat / Brause, Barry / Chen, Antonia F / Gililland, Jeremy / Goodman, Mark / Hurley-Rosenblatt, Arlene / Kirou, Kyriakos / Losina, Elena / MacKenzie, Ronald / Michaud, Kaleb / Mikuls, Ted / Russell, Linda / Sah, Alexander / Miller, Amy S / Singh, Jasvinder A / Yates, Adolph. ·Hospital for Special Surgery/Weill Cornell Medicine, New York, New York. · OrthoCarolina Hip and Knee Center, Charlotte, North Carolina. · McMaster University, Hamilton, Ontario, Canada. · Mayo Clinic, Rochester, Minnesota. · Louisiana State University, New Orleans. · University of Pennsylvania, Philadelphia. · University of Michigan, Ann Arbor. · Columbia University, New York, New York. · Albert Einstein College of Medicine, Bronx, New York. · Kaiser Permanente, Fontana, California. · Cleveland Clinic, Cleveland, Ohio. · Midwest Orthopaedics at Rush, Chicago, Illinois. · University of Texas Medical Branch, Galveston. · American College of Rheumatology, Atlanta, Georgia. · Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. · University of Utah, Salt Lake City. · University of Pittsburgh, Pittsburgh, Pennsylvania. · Rockefeller University, New York, New York. · Brigham and Women's Hospital, Boston, Massachusetts. · National Data Bank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha. · University of Nebraska Medical Center, Omaha. · Dearborn-Sah Institute for Joint Restoration, Fremont, California. · University of Alabama at Birmingham. ·Arthritis Rheumatol · Pubmed #28620948.

ABSTRACT: OBJECTIVE: This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). METHODS: A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. RESULTS: The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence. CONCLUSION: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.

17 Guideline Stereotactic body radiotherapy for de novo spinal metastases: systematic review. 2017

Husain, Zain A / Sahgal, Arjun / De Salles, Antonio / Funaro, Melissa / Glover, Janis / Hayashi, Motohiro / Hiraoka, Masahiro / Levivier, Marc / Ma, Lijun / Martínez-Alvarez, Roberto / Paddick, J Ian / Régis, Jean / Slotman, Ben J / Ryu, Samuel. ·Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut. · Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada. · Department of Neurosurgery, University of California, Los Angeles, California. · Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut. · Department of Neurosurgery, Tokyo Women's Medical University, Tokyo. · Department of Radiation Oncology, Kyoto University, Kyoto, Japan. · Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. · Division of Physics, Department of Radiation Oncology, University of California, San Francisco, California. · Department of Neurosurgery, Ruber International Hospital, Madrid, Spain. · National Hospital for Neurology and Neurosurgery, London, United Kingdom. · Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France. · Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; and. · Department of Radiation Oncology, Stony Brook University, Stony Brook, New York. ·J Neurosurg Spine · Pubmed #28598293.

ABSTRACT: OBJECTIVE The aim of this systematic review was to provide an objective summary of the published literature pertaining to the use of stereotactic body radiation therapy (SBRT) specific to previously untreated spinal metastases. METHODS The authors performed a systematic review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, of the literature found in a search of Medline, PubMed, Embase, and the Cochrane Library up to March 2015. The search strategy was limited to publications in the English language. RESULTS A total of 14 full-text articles were included in the analysis. All studies were retrospective except for 2 studies, which were prospective. A total of 1024 treated spinal lesions were analyzed. The median follow-up time ranged from 9 to 49 months. A range of dose-fractionation schemes was used, the most common of which were 16-24 Gy/1 fraction (fx), 24 Gy/2 fx, 24-27 Gy/3 fx, and 30-35 Gy/5 fx. In studies that reported crude results regarding in-field local tumor control, 346 (85%) of 407 lesions remained controlled. For studies that reported actuarial values, the weighted average revealed a 90% 1-year local control rate. Only 3 studies reported data on complete pain response, and the weighted average of these results yielded a complete pain response rate of 54%. The most common toxicity was new or progressing vertebral compression fracture, which was observed in 9.4% of cases; 2 cases (0.2%) of neurologic injury were reported. CONCLUSION There is a paucity of prospective data specific to SBRT in patients with spinal metastases not otherwise irradiated. This systematic review found that SBRT is associated with favorable rates of local control (approximately 90% at 1 year) and complete pain response (approximately 50%), and low rates of serious adverse events were found. Practice guidelines are summarized based on these data and International Stereotactic Radiosurgery Society consensus.

18 Guideline ACR Appropriateness Criteria 2017

Anonymous3930905 / Bernard, Stephanie A / Kransdorf, Mark J / Beaman, Francesca D / Adler, Ronald S / Amini, Behrang / Appel, Marc / Arnold, Erin / Cassidy, R Carter / Greenspan, Bennett S / Lee, Kenneth S / Tuite, Michael J / Walker, Eric A / Ward, Robert J / Wessell, Daniel E / Weissman, Barbara N. ·Principal Author, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Electronic address: sbernard@psu.edu. · Panel Chair, Mayo Clinic, Phoenix, Arizona. · Panel Vice-Chair, University of Kentucky, Lexington, Kentucky. · NYU Center for Musculoskeletal Care, New York, New York. · University of Texas MD Anderson Cancer Center, Houston, Texas. · James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons. · Orthopaedics and Rheumatology of the North Shore, Skokie, Illinois; American College of Rheumatology. · UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons. · Medical College of Georgia at Georgia Regents University, Augusta, Georgia. · University of Wisconsin Hospital & Clinics, Madison, Wisconsin. · Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. · Tufts Medical Center, Boston, Massachusetts. · Mayo Clinic, Jacksonville, Florida. · Specialty Chair, Brigham & Women's Hospital, Boston, Massachusetts. ·J Am Coll Radiol · Pubmed #28473095.

ABSTRACT: Inflammatory sacroiliitis or the seronegative axial spondyloarthropathies often presents as back pain or sacroiliac joint pain of more than 3-month duration with inflammatory symptoms and typically in patients younger than 45 years of age. Imaging plays an important role in diagnosis and disease monitoring. This article addresses the appropriate sequence of initial imaging for evaluation of a suspected spondyloarthropathy, the imaging follow-up of treatment response and the special considerations for imaging of trauma in patients with ankylosis of the spine. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

19 Guideline ACR Appropriateness Criteria 2017

Anonymous3670905 / Booth, Timothy N / Iyer, Ramesh S / Falcone, Richard A / Hayes, Laura L / Jones, Jeremy Y / Kadom, Nadja / Kulkarni, Abhaya V / Myseros, John S / Partap, Sonia / Reitman, Charles / Robertson, Richard L / Ryan, Maura E / Saigal, Gaurav / Soares, Bruno P / Tekes-Brady, Aylin / Trout, Andrew T / Zumberge, Nicholas A / Coley, Brian D / Palasis, Susan. ·Principal Author, Children's Medical Center, Dallas, Texas. Electronic address: tim.booth@childrens.com. · Co-Author, Seattle Children's Hospital, Seattle, Washington. · Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; American Pediatric Surgical Association. · Children's Healthcare of Atlanta, Atlanta, Georgia. · Texas Children's Hospital, Houston, Texas. · Emory University and Children's of Atlanta (Egleston), Atlanta, Georgia. · Hospital for Sick Children, Toronto, Ontario, Canada, neurosurgical consultant. · Children's National Medical Center, Washington, District of Columbia, neurosurgical consultant. · Stanford University, Stanford, California; American Academy of Pediatrics. · Medical University of South Carolina, Charleston, South Carolina; North American Spine Society. · Boston Children's Hospital, Boston, Massachusetts. · Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. · Jackson Memorial Hospital, Miami, Florida. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · Johns Hopkins Medical Institute, Baltimore, Maryland. · Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. · Nationwide Children's Hospital, Columbus, Ohio. · Specialty Chair, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. · Panel Chair, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia. ·J Am Coll Radiol · Pubmed #28473069.

ABSTRACT: It is now generally accepted that nontraumatic back pain in the pediatric population is common. The presence of isolated back pain in a child has previously been an indication for imaging; however, recently a more conservative approach has been suggested using clinical criteria. The presence of constant pain, night pain, and radicular pain, alone or in combination, lasting for 4 weeks or more, constitute clinical red flags that should prompt further imaging. Without these clinical red flags, imaging is likely not indicated. Exceptions include an abnormal neurologic examination or clinical and laboratory findings suggesting an infectious or neoplastic etiology, and when present should prompt immediate imaging. Initial imaging should consist of spine radiographs limited to area of interest, with spine MRI without contrast to evaluate further if needed. CT of the spine, limited to area of interest, and Tc-99m bone scan whole body with single-photon emission computed tomography may be useful in some patients. The addition of intravenous contrast is also recommended for evaluation of a potential neoplastic or infectious process. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

20 Guideline 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. 2017

van der Heijde, Désirée / Ramiro, Sofia / Landewé, Robert / Baraliakos, Xenofon / Van den Bosch, Filip / Sepriano, Alexandre / Regel, Andrea / Ciurea, Adrian / Dagfinrud, Hanne / Dougados, Maxime / van Gaalen, Floris / Géher, Pál / van der Horst-Bruinsma, Irene / Inman, Robert D / Jongkees, Merryn / Kiltz, Uta / Kvien, Tore K / Machado, Pedro M / Marzo-Ortega, Helena / Molto, Anna / Navarro-Compàn, Victoria / Ozgocmen, Salih / Pimentel-Santos, Fernando M / Reveille, John / Rudwaleit, Martin / Sieper, Jochen / Sampaio-Barros, Percival / Wiek, Dieter / Braun, Jürgen. ·Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. · Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands. · Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands. · Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany. · Department of Rheumatology, Ghent University and Ghent University Hospital, Ghent, Belgium. · NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal. · Department of Rheumatology, University Hospital Zurich, Zurich Switzerland. · Diakonhjemmet Hospital, Oslo, Norway. · Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France. · INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France. · Semmelweis University, Budapest, Hungary. · Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands. · University of Toronto, Toronto, Ontario, Canada. · Patient Research Partner, Amsterdam, The Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK. · NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK. · Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK. · Department of Rheumatology, University Hospital La Paz, IdiPaz, Madrid, Spain. · Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey. · NOVA Medical School, NOVA University of Lisbon, Lisboa, Portugal. · The University of Texas-Health McGovern Medical School, Dallas, USA. · Klinikum Bielefeld, Bielefeld, Germany. · Gent University, Gent, Belgium. · Charité University Medicine, Berlin, Germany. · Department of Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany. · Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. · EULAR PARE Patient Research Partner and Chair of EULAR PARE, Berlin, Germany. ·Ann Rheum Dis · Pubmed #28087505.

ABSTRACT: To update and integrate the recommendations for ankylosing spondylitis and the recommendations for the use of tumour necrosis factor inhibitors (TNFi) in axial spondyloarthritis (axSpA) into one set applicable to the full spectrum of patients with axSpA. Following the latest version of the European League Against Rheumatism (EULAR) Standardised Operating Procedures, two systematic literature reviews first collected the evidence regarding all treatment options (pharmacological and non-pharmacological) that were published since 2009. After a discussion of the results in the steering group and presentation to the task force, overarching principles and recommendations were formulated, and consensus was obtained by informal voting. A total of 5 overarching principles and 13 recommendations were agreed on. The first three recommendations deal with personalised medicine including treatment target and monitoring. Recommendation 4 covers non-pharmacological management. Recommendation 5 describes the central role of non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice drug treatment. Recommendations 6-8 define the rather modest role of analgesics, and disprove glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for axSpA patents with predominant axial involvement. Recommendation 9 refers to biological DMARDs (bDMARDs) including TNFi and IL-17 inhibitors (IL-17i) for patients with high disease activity despite the use (or intolerance/contraindication) of at least two NSAIDs. In addition, they should either have an elevated C reactive protein and/or definite inflammation on MRI and/or radiographic evidence of sacroiliitis. Current practice is to start with a TNFi. Switching to another TNFi or an IL-17i is recommended in case TNFi fails (recommendation 10). Tapering, but not stopping a bDMARD, can be considered in patients in sustained remission (recommendation 11). The final two recommendations (12, 13) deal with surgery and spinal fractures. The 2016 Assessment of SpondyloArthritis international Society-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.

21 Guideline EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. 2017

Agca, R / Heslinga, S C / Rollefstad, S / Heslinga, M / McInnes, I B / Peters, M J L / Kvien, T K / Dougados, M / Radner, H / Atzeni, F / Primdahl, J / Södergren, A / Wallberg Jonsson, S / van Rompay, J / Zabalan, C / Pedersen, T R / Jacobsson, L / de Vlam, K / Gonzalez-Gay, M A / Semb, A G / Kitas, G D / Smulders, Y M / Szekanecz, Z / Sattar, N / Symmons, D P M / Nurmohamed, M T. ·Departments of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands. · Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway. · College of Medical, Veterinary and Life Sciences, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK. · Internal and Vascular Medicine, VU University Medical Center, Amsterdam, The Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Rheumatology, Paris Descartes University, Hôpital Cochin. Assistance Publique, Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France. · Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria. · IRCCS Galeazzi Orthopedic Institute, Milan, Italy. · Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark. · Sygehus Sønderjylland (Hospital of Southern Jutland), Aabenraa, Denmark. · King Christian 10's Hospital for Rheumatic Diseases, Graasten, Denmark. · Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden. · PARE (patient research partners), Sint-Joris-Weert, Belgium. · Romanian League Against Rheumatism (Vice-President) and Board Member (General Secretary) of AGORA, the Platform of S-E organisations for patients with RMDs, Bucharest, Romania. · Oslo University Hospital, Ullevål, Center for Preventive Medicine and Medical Faculty, University of Oslo, Oslo, Norway. · Department of Rheumatology & Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg and Section of Rheumatology, Lund, Sweden. · Department of Clinical Sciences Malmö, Lund University, Lund, Sweden. · Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium. · University of Cantabria, IDIVAL, Santander, Spain. · Head of Research and Development, Academic Affairs Dudley Group NHS Foundation Trust, Arthritis Research UK Centre for Epidemiology, University of Manchester, Russells Hall Hospital, Clinical Research Unit, Dudley, UK. · Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, University of Debrecen, Debrecen, Hungary. · Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK. · Department of Rheumatology and Musculoskeletal Epidemiology, Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK. · Department of Rheumatology Reade, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands. ·Ann Rheum Dis · Pubmed #27697765.

ABSTRACT: Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.

22 Guideline BSR and BHPR guideline for the treatment of axial spondyloarthritis (including ankylosing spondylitis) with biologics. 2017

Hamilton, Louise / Barkham, Nick / Bhalla, Ashok / Brittain, Robin / Cook, Debbie / Jones, Gareth / Mackay, Kirsten / Marshall, David / Marzo-Ortega, Helena / Murphy, Daniel / Riddell, Claire / Sengupta, Raj / Siebert, Stefan / Van Rossen, Liz / Gaffney, Karl / Anonymous2740879. ·Rheumatology Department, Norfolk and Norwich University Hospital, Norwich louise.hamilton@nnuh.nhs.uk. · Rheumatology Department, New Cross Hospital, Wolverhampton. · Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Bath. · Private residence, Grantham. · National Ankylosing Spondylitis Society, London, UK. · Institute of Applied Health Sciences, University of Aberdeen, Aberdeen. · Rheumatology Department, Torbay Hospital, Torquay. · Rheumatology Department, Inverclyde Royal Hospital, Greenock. · NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds. · Honiton Surgery and Rheumatology Department, Royal Devon and Exeter Hospital, Exeter. · Rheumatology Department, Musgrave Park Hospital, Belfast Health and Social Care Trust, Belfast. · Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow. · Rheumatology Department, Kent and Canterbury Hospital, Canterbury. · Rheumatology Department, Norfolk and Norwich University Hospital, Norwich. ·Rheumatology (Oxford) · Pubmed #27558584.

ABSTRACT: -- No abstract --

23 Guideline Singapore Chapter of Rheumatologists consensus statement on the eligibility for government subsidy of biologic disease modifying anti-rheumatic agents for the treatment of psoriatic arthritis. 2017

Lahiri, Manjari / Teng, Gim-Gee / Cheung, Peter P / Suresh, Ernest / Chia, Faith L / Lui, Nai-Lee / Koh, Dow-Rhoon / Koh, Wei-Howe / Leong, Khai-Pang / Lim, Anita Y N / Ng, Swee-Cheng / Thumboo, Julian / Lau, Tang-Ching / Leong, Keng-Hong. ·Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore. · Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. · Department of Medicine, Alexandra Hospital (Jurong Health), Singapore, Singapore. · Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore. · Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore. · Koh Wei Howe Arthritis & Rheumatism Medical Clinic, Mount Elizabeth Medical Centre, Singapore, Singapore. · Leong Keng Hong Arthritis and Medical Clinic, Gleneagles Medical Centre, Singapore, Singapore. ·Int J Rheum Dis · Pubmed #26353916.

ABSTRACT: AIM: In Singapore, patients with psoriatic arthritis (PsA) constitute a significant disease burden. There is good evidence for the efficacy of anti-tumor necrosis factor (anti-TNF) in PsA; however cost remains a limiting factor. Non-biologic disease modifying anti-rheumatic drugs (nbDMARDs) hence remain the first-line treatment option in PsA in spite of limited evidence. The Singapore Chapter of Rheumatologists aims to develop national guidelines for clinical eligibility for government-assisted funding of biologic disease modifying anti- rheumatic drugs (bDMARDs) for PsA patients in Singapore. METHODS: Evidence synthesis was performed by reviewing seven published guidelines on use of biologics for PsA. Using the modified Research and Development/University of California at Los Angeles Appropriateness Method (RAM), rheumatologists rated indications for therapies for different clinical scenarios. Points reflecting the output from the formal group consensus were used to formulate the practice recommendations. RESULTS: Ten recommendations were formulated relating to initiation, continuation and options of bDMARD therapy. The panellists agreed that a bDMARD is indicated if a patient has active PsA with at least five swollen and tender joints, digits or entheses and has failed two nbDMARD strategies at optimal doses for at least 3 months each. Any anti-TNF may be used and therapy may be continued if an adequate PsARC response is achieved by 3 months after commencement. CONCLUSION: The recommendations developed by a formal group consensus method may be useful for clinical practice and guiding funding decisions by relevant authorities in making bDMARD usage accessible and equitable to eligible patients in Singapore.

24 Guideline Consensus development on eligibility of government subsidisation of biologic disease modifying anti-rheumatic agents for treatment of ankylosing spondylitis: The Singapore experience. 2017

Cheung, Peter P / Lahiri, Manjari / Teng, Gim-Gee / Lui, Nai-Lee / Chia, Faith L / Koh, Dow-Rhoon / Koh, Wei-Howe / Ng, Swee-Cheng / Suresh, Ernest / Leong, Khai-Pang / Lim, Anita Y N / Thumboo, Julian / Lau, Tang-Ching / Leong, Keng-Hong. ·Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore. · Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · Department of Rheumatology and Immunology, Singapore General Hospital, Singapore. · Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore. · Koh Wei Howe Arthritis & Rheumatism Medical Clinic, Mount Elizabeth Medical Centre, Singapore. · Department of Medicine, Khoo Teck Puat Hospital, Singapore. · Department of Medicine, Alexandra Hospital (Jurong Health), Singapore. · Leong Keng Hong Arthritis and Medical Clinic, Gleneagles Medical Centre, Singapore. ·Int J Rheum Dis · Pubmed #26177789.

ABSTRACT: INTRODUCTION: The beneficial effects of biologic disease-modifying anti-rheumatic drugs (bDMARDs), such as tumour necrosis factor inhibitors (anti-TNF) in active ankylosing spondylitis (AS) are well established. The significant costs on patients in the absence of financial subsidization can limit their use. The objective was to describe a consensus development process on recommendations for government-assisted funding of biologic therapy for AS patients in Singapore. METHODS: Evidence synthesis followed by a modified RAND/UCLA Appropriateness Method (RAM) was used. Eleven rheumatologists rated indications for therapies for different proposed clinical scenarios. Points reflecting the output from the formal group consensus were used to formulate 10 practice recommendations. RESULTS: It was agreed that a bDMARD (anti-TNF) is indicated if a patient has active AS with a Bath Ankylosing Spondylitis Activity Index (BASDAI) ≥ 4 and spinal pain of ≥ 4 cm on visual analogue scale (VAS) on two occasions at least 12 weeks apart, despite being on a minimum of two sequential non-steroidal anti-inflammatory drugs at maximal tolerated dose for at least 4 weeks, in addition to adherence to an appropriate physiotherapy program for at least 3 months. To qualify for continued biologic therapy, a patient must have documentation of response every 3 months and at least 50% improvement in BASDAI and reduction of spinal pain VAS ≥ 2 cm. CONCLUSION: A validated and feasible consensus process can enable pragmatic standardized recommendations to be developed for bDMARD subsidization for AS patients in a local Asian context.

25 Guideline AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine. 2016

Anonymous7000879. · ·J Ultrasound Med · Pubmed #27574123.

ABSTRACT: -- No abstract --

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