Tunisian recommendations of good practice for the therapeutic management of spondyloarthritis (excluding biological treatment)

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Published Jan 2, 2025
https://doi.org/10.62438/tunismed.v103i1.5563
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Vol. 103 No. 1 (2025): Tunis Med Jan 2025

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Ahmed Laatar
Department of Rheumatology, Mongi Slim Hospital, La Marsa. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Saoussen Miladi
Department of Rheumatology, Mongi Slim Hospital, La Marsa. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Alia Fazaa
Department of Rheumatology, Mongi Slim Hospital, La Marsa. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Raoudha Tekaya
Department of Rheumatology, Charles Nicolle Hospital. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Aicha Ben Tekaya
Department of Rheumatology, Charles Nicolle Hospital. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Mohamed Manaa
Department of Internal Medicine, Hospital of the Internal Security Forces, La Marsa. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Imen Gharsallah
Department of Rheumatology, Military Hospital of Tunis . Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Nadia 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
Ines Mahmoud
Department of Rheumatology, Charles Nicolle Hospital. Faculty of Medicine of Tunis, University of Tunis El Manar, 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, Tunisia
Wafa Hamdi
Department of Rheumatology, Kassab Institute of Orthopaedics, Mannouba. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Saoussen Zrour
Department of Rheumatology, Fattouma Bourguiba Hospital, Monastir. Faculty of Medicine of Monastir, University of Monastir, 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 develop good practice recommendations (GPR) for the therapeutic management of patients with spondyloarthritis (SpA), including psoriatic arthritis.


Methods: Following standardised procedures, a systematic review of the literature was carried out on non-pharmacological and non-biological pharmacological treatments for SpA. The review was based on questions defined by a working group of 15 rheumatologists. The data was evaluated at group meetings, which led to the drafting of recommendations, the assignment of a grade to each recommendation and the determination of the level of agreement between the experts.


Results: A general principle and 11 recommendations were developed. The recommendations focus on treatment modalities, taking into account the dominant phenotype (axial, articular peripheral, enthesitic peripheral) and extra-articular manifestations (psoriasis, chronic inflammatory bowel disease (IBD)). The first recommendation concerns therapeutic patient education. Recommendations 2 to 4 focus on NSAIDs as the first-line pharmacological treatment for the various presentations of the disease, with the exception of those associated with IBD, as well as their prescribing modalities. Recommendation 5 deals with analgesics. Recommendation 6 limits the use of glucocorticoids to symptomatic peripheral arthritis and advises against their long-term use. Recommendation 7 deals with radioisotope synoviorthesis for refractory arthritis of the hips and knees. Conventional Synthetic Disease-Modifying AntiRheumatic Drugs (csDMARDs) are not recommended for SpA which is axial, enthesitic or involves dactylitis (recommendation 8). JAK inhibitors are recommended for axial SpA and for joint and skin involvement of psoriatic arthritis in failure of symptomatic treatment, csDMARDs and/or bDMARDs (recommendation 9). The latest ...(abstract truncated at 250 words).

Keywords:

Spondyloarthritis, csDMARDs, Ankylosing Spondylitis, Effectiveness, Psoriatic arthritis, IBD-associated spondyloarthritis, Treatment, NSAIDS, Corticoids

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