Tunisian Good Clinical Practice Recommendations for the Management of Spondyloarthritis by Biological Agents

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Published Jan 2, 2025
https://doi.org/10.62438/tunismed.v103i1.5555
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Vol. 103 No. 1 (2025): Tunis Med Jan 2025

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Rawdha Tekaya
Department of Rheumatology, Charles Nicolle Hospital, Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Aicha Ben Tekaya
Department of Rheumatology, Charles Nicolle Hospital, Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Inès Mahmoud
Department of Rheumatology, Charles Nicolle Hospital, Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Mohamed Manaa
Department of Rheumatology, Mongi Slim Hospital, La Marsa. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Imene Gharsallah
Department of Rheumatology, Military Hospital of Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Nédia Testouri
Department of Internal Medicine, Habib Thameur Hospital, Tunis, Tunisia
Khadija Baccouche
Department of Rheumatology, Farhat Hached Hospital, Sousse. Ibn El Jazzar Faculty of Medicine of Sousse, University of Sousse, Tunisia
Saoussen Zrour
Department of Rheumatology, Fattouma Bourguiba Hospital, Monastir. Faculty of Medicine of Monastir, University of Monastir, Tunisia
Kaouther Maatallah
Department of Rheumatology, Kassab Institute of Orthopaedics, Mannouba. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Mohamed Younès
Department of Rheumatology, Tahar Sfar Hospital, Mahdia. Faculty of Medicine of Monastir, University of Monastir, Mahdia, Tunisia
Wafa Hamdi
Department of Rheumatology, Kassab Institute of Orthopaedics, Mannouba. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Alia Fazaa
Department of Internal Medicine, Hospital of the Internal Security Forces, La Marsa. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Saoussen Miladi
Department of Internal Medicine, Hospital of the Internal Security Forces, La Marsa. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Ahmed Laatar
Department of Internal Medicine, Hospital of the Internal Security Forces, La Marsa. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Mohamed Montacer Kchir
Department of Rheumatology, Kassab Institute of Orthopaedics, Mannouba. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia

Abstract

 


Aim: To elaborate  Tunisian recommendations for the therapeutic management in current practice of patients with spondyloarthritis who are candidates for treatment with a biological agent.


Methods : Following the standardized procedures of the INEAS (Instance Nationale de l'Evaluation et de l'Accréditation en Santé) and in collaboration with the LITAR (Tunisian League against Rheumatism), a systematic review of the literature, carried out by 6 rheumatologists, based on the questions individualized by the working group (15 expert rheumatologists), served as the basis for the working meetings, with determination of the strength of the recommendations and the degree of agreement of the experts.  The recommendations were validated by an independent reading group comprising 19 experts from various related specialties.


Results: Ten recommendations for good practice were drawn up. The first 2 recommendations concern the pre-therapeutic assessment and the updating of immunisation status prior to the initiation of biotherapy. Recommendations 3 to 8 deal with the use of biologics, including the new classes, in their indications (active disease despite conventional treatment, and for non-radiographic axial forms, presence of objective signs of inflammation) and follow-up, and their management in the event of failure or in remission. Recommendations 9 and 10 concern management in the event of pregnancy or neoplasia. The strength of the recommendations ranged from 8 to 9, with a degree of agreement of between 72% and 100%.


Conclusion:This work, supported by LITAR and accredited by INEAS, takes into account the data in the literature and the predominant clinical presentation....( abstract truncated at 250 words).

Keywords:

Spondyloarthritis, Treatment, Recommendations

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Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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