Brazilian recommendations for the use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis

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.(AU)

The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis - 2019

Abstract Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013. A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed. These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.

Avaliação clínica, laboratorial e radiográfica de brasileiros com espondiloartropatias / Clinical, laboratorial and radiographic evaluation in Brazilians with spondyloarthropaties

OBJETIVO: analisar o padrão de doença de pacientes brasileiros com espondiloartropatias (EAP). PACIENTES E MÉTODOS: foram avaliados 156 pacientes por meio de análise descritiva e análise de associação uni e multivariada entre a distribuição das manifestações clínicas, laboratoriais e radiográficas e a presença do HLA-B27. RESULTADOS: as doenças do grupo identificadas foram a espondilite anquilosante - EA (48,10 por cento), a espondiloartropatia indiferenciada (20,51 por cento), a artrite reativa - ARe (15,39 por cento), a artrite psoriásica - AP (14,10 por cento) e a artropatia das doenças inflamatórias intestinais (1,92 por cento). O HLA-B27 foi positivo em 53,85 por cento dos pacientes. O HLA-B27 positivo associou-se ao acometimento clínico e/ou radiográfico das articulações sacroilíacas (p=0,007; OR=3,13; IC 95 por cento 1,38 a 7,06), à presença de sacroiliíte radiográfica > grau II bilateral (p=0,05; OR=2,85; IC 95 por cento 1,02 a 8,04) e ao sexo masculino (p=<0,001; OR=3,00; IC 95 por cento 1,83 a 4,92), enquanto indivíduos com o HLA-B27 negativo apresentaram, significativamente, mais balanite como manifestação evolutiva que indivíduos HLA-B27 positivos (p=0,03; OR=0,21; IC 95 por cento 0,05 a 0,88). CONCLUSÃO: as manifestações clínicas, laboratoriais e radiográficas foram semelhantes às descritas em outros trabalhos. O HLA-B27 apresentou-se em baixa freqüência, quando comparado com outras amostras, e ocorreram associações entre este antígeno e o sexo masculino e o envolvimento das articulações sacroilíacas.

OBJECTIVE: to evaluate disease manifestations of Brazilian patients with spondyloarthropathies. METHODS: a group of 156 patients was studied in a descriptive evaluation the analysis of the association between clinical, laboratory and radiographic aspects and the presence of the HLA-B27 was done. RESULTS: the following diseases were identified: ankylosing spondylitis (48.10 percent), undifferentiated spondyloarthropathy (20.51 percent), reactive arthritis (15.39 percent), psoriatic arthritis (14.10 percent) and inflammatory bowel disease arthropathy (1.92 percent). The HLA-B27 was identified in 53.85 percent. HLA-B27 presence was associated with clinical and/or radiographic findings of sacroiliac joints involvement (p=0.007; OR=3.13; CI 95 percent 1.38 to 7.06), with the presence of radiographic bilateral sacroiliitis > grade II, bilateral (p=0.05; OR=2.85; IC 95 percent 1.02 to 8.04) and with male gender (p=<0.001; OR=3.00; CI 95 percent 1.83 to 4.92). On the other hand, negative HLA-B27 was significantly associated with the occurrence of balanitis during the course of the disease (p=0.03; OR=0.21; IC 95 percent 0.05 to 0.88). CONCLUSION: clinical, laboratory and radiographic manifestations were similar to those reported by other studies. The frequency of HLA-B27 was low when compared to other studies. A significant association was observed between the HLA-B27 and gender as well as compromised sacroiliac joints.