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Journal of Rheumatic Diseases and Treatment





DOI: 10.23937/2469-5726/1510018



A Flowchart For Understanding Ankylosing Spondylitis Management Recommendations of Asas/Eular

Nihal Ozaras*


Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University of Istanbul, Turkey


*Corresponding author: Nihal Ozaras, Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University of Istanbul, Turkey, E-mail: nihalozaras@yahoo.com
J Rheum Dis Treat, JRDT-1-018, (Volume 1, Issue 3), Letter; ISSN: 2469-5726
Received: July 11, 2015 | Accepted: July 31, 2015 | Published: August 03, 2015
Citation: Ozaras N (2015) A Flowchart For Understanding Ankylosing Spondylitis Management Recommendations of Asas/Eular. J Rheum Dis Treat 1:018. 10.23937/2469-5726/1510018
Copyright: © 2015 Ozaras N. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Abstract

Ankylosing spondylitis (AS) is one of the most frequently seen rheumatic diseases in clinical practice. Its treatment is defined by the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR). A flowchart is designed to easily understand this treatment strategy.


Keywords

Ankylosing spondylitis, Management, ASAS, EULAR, Flowchart


Letter

Ankylosing spondylitis (AS) is one of the most frequently seen rheumatic diseases in clinical practice [1,2]. Its treatment strategy is determined by the concensus opinion of the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) [3,4]. A flowchart was designed reflecting these ASAS/EULAR recommendations clearly (Figure 1). The direction of the disease progression is given by an arrow containing the important progression criteriae. Step by step the treatment approach is given: After the diagnosis, all the patients should be educated about the disease nature, possible clinical courses and treatment options. The basic exercises should be teached and the recommendation of life long exercise must be emphasized. The NSAIDs are shown in the second step of the figure as the first line drug treatment and it is highlighted by typing it in bold letters. As recommended, the analgesics, opioids and local steroids may be used when the NSAID therapy is not enough for pain and they take place in the third step. Sulphasalazine is the next step if there is peripheral SpA. At the last step if the disease is not under control with the previos treatments anti -TNF treatment must be used. The surgery is not added to the figure since it can be done at any step in the selected patients.


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Figure 1: Recommendations of ASAS/ EULAR in AS treatment. View Figure 1



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In conclusion, this flowchart describes the ASAS/ EULAR recommendations clearly and it is easily solvable.


References
  1. Baraliakos X, Braun J (2011) Spondyloarthritides. Best Pract Res Clin Rheumatol 25: 825-842.

  2. Braun J (2009) Therapy of spondyloarthritides. Adv Exp Med Biol 649: 133-147.

  3. Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, et al. (2009) The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 68: 1-44.

  4. Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, et al. (2011) 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 70: 896-904.

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