Evidence map›Paper›PMID 31436036›Full record

GuidelineArthritis & rheumatology (Hoboken, N.J.)2019

2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis.

Michael M Ward, Atul Deodhar, Lianne S Gensler, Maureen Dubreuil, David Yu, Muhammad Asim Khan, Nigil Haroon, David Borenstein, Runsheng Wang, Ann Biehl and 13 more

Abstract readPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in Arthritis & rheumatology (Hoboken, N.J.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 327 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
327citing papers in PubMed, 11 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

327 citing papers in PubMed, 11 syntheses or guidelines pooled it.

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  4. La Tunisie medicale · 2025
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267 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

23 authors.

Michael M WardNational Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland.
Atul DeodharOregon Health & Science University, Portland.
Lianne S GenslerUniversity of California, San Francisco.
Maureen DubreuilBoston University School of Medicine, Boston, Massachusetts.ORCID 0000-0002-6253-1515
David YuUniversity of California, Los Angeles.
Muhammad Asim KhanCase Western Reserve University, Cleveland, Ohio.
Nigil HaroonUniversity of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada.ORCID 0000-0003-3210-4771
David BorensteinArthritis & Rheumatism Associates, Washington, DC.
Runsheng WangColumbia University Medical Center, New York, New York.ORCID 0000-0001-8115-7509
Ann BiehlNational Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland.
Meika A FangVA West Los Angeles Medical Center, Los Angeles, California.
Grant LouieArthritis and Rheumatism Associates, Wheaton, Maryland.
Vikas MajithiaUniversity of Mississippi Medical Center, Jackson.ORCID 0000-0003-3627-4399
Bernard NgUniversity of Washington, Seattle.
Rosemary BighamSeattle, Washington.
Michael PianinPianin and Associates, PC, Phoenix, Arizona.
Amit Aakash ShahAmerican College of Rheumatology, Atlanta, Georgia.
Nancy SullivanECRI Institute, Plymouth Meeting, Pennsylvania.
Marat TurgunbaevAmerican College of Rheumatology, Atlanta, Georgia.
Jeff OristaglioECRI Institute, Plymouth Meeting, Pennsylvania.
Amy TurnerAmerican College of Rheumatology, Atlanta, Georgia.
Walter P MaksymowychUniversity of Alberta, Edmonton, Alberta, Canada.
Liron CaplanRocky Mountain Regional VA Medical Center and University of Colorado, Aurora.ORCID 0000-0002-2799-3036

Funding

Outcomes in Rheumatic DiseasesZ01AR041153 · NIAMS · NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES · PI WARD, MICHAEL · 2005 to 2008
$1.6M
American College of RheumatologyIntramural NIH HHS Z01 AR041153Spondylitis Association of AmericaSpondyloarthritis Research and Treatment Network
6 · The paper itself

Abstract

objectiveTo update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).

methodsWe conducted updated systematic literature reviews for 20 clinical questions on pharmacologic treatment addressed in the 2015 guidelines, and for 26 new questions on pharmacologic treatment, treat-to-target strategy, and use of imaging. New questions addressed the use of secukinumab, ixekizumab, tofacitinib, tumor necrosis factor inhibitor (TNFi) biosimilars, and biologic tapering/discontinuation, among others. We used the Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations and required at least 70% agreement among the voting panel.

resultsRecommendations for AS and nonradiographic axial SpA are similar. TNFi are recommended over secukinumab or ixekizumab as the first biologic to be used. Secukinumab or ixekizumab is recommended over the use of a second TNFi in patients with primary nonresponse to the first TNFi. TNFi, secukinumab, and ixekizumab are favored over tofacitinib. Co-administration of low-dose methotrexate with TNFi is not recommended, nor is a strict treat-to-target strategy or discontinuation or tapering of biologics in patients with stable disease. Sulfasalazine is recommended only for persistent peripheral arthritis when TNFi are contraindicated. For patients with unclear disease activity, spine or pelvis magnetic resonance imaging could aid assessment. Routine monitoring of radiographic changes with serial spine radiographs is not recommended.

conclusionThese recommendations provide updated guidance regarding use of new medications and imaging of the axial skeleton in the management of AS and nonradiographic axial SpA.

Indexed as

Antibodies, Monoclonal, HumanizedAnti-Inflammatory Agents, Non-SteroidalAntirheumatic AgentsBiological ProductsBiosimilar PharmaceuticalsDeprescriptionsHumansMagnetic Resonance ImagingPiperidinesProtein Kinase InhibitorsPyrimidinesPyrrolesRadiographySocieties, MedicalSpondylarthropathiesSpondylitis, AnkylosingAntibodies, Monoclonal, HumanizedAnti-Inflammatory Agents, Non-SteroidalAntirheumatic AgentsBiological ProductsBiosimilar PharmaceuticalsixekizumabPiperidinesProtein Kinase InhibitorsPyrimidinesPyrrolessecukinumabtofacitinibTumor Necrosis Factor Inhibitors

Identifiers

PMID31436036
PMCPMC6764882

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.