American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: ACR/SAA/Spartan Treatment Recommendations in as

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Abstract

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

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Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.

Brooke Coombes, Leanne Bisset, Bill Vicenzino (2010)

Few evidence-based treatment guidelines for tendinopathy exist. We undertook a systematic review of randomised trials to establish clinical efficacy and risk of adverse events for treatment by injection. We searched eight databases without language, publication, or date restrictions. We included randomised trials assessing efficacy of one or more peritendinous injections with placebo or non-surgical interventions for tendinopathy, scoring more than 50% on the modified physiotherapy evidence database scale. We undertook meta-analyses with a random-effects model, and estimated relative risk and standardised mean differences (SMDs). The primary outcome of clinical efficacy was protocol-defined pain score in the short term (4 weeks, range 0-12), intermediate term (26 weeks, 13-26), or long term (52 weeks, ≥52). Adverse events were also reported. 3824 trials were identified and 41 met inclusion criteria, providing data for 2672 participants. We showed consistent findings between many high-quality randomised controlled trials that corticosteroid injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms. For example, in pooled analysis of treatment for lateral epicondylalgia, corticosteroid injection had a large effect (defined as SMD>0·8) on reduction of pain compared with no intervention in the short term (SMD 1·44, 95% CI 1·17-1·71, p<0·0001), but no intervention was favoured at intermediate term (-0·40, -0·67 to -0·14, p<0·003) and long term (-0·31, -0·61 to -0·01, p=0·05). Short-term efficacy of corticosteroid injections for rotator-cuff tendinopathy is not clear. Of 991 participants who received corticosteroid injections in studies that reported adverse events, only one (0·1%) had a serious adverse event (tendon rupture). By comparison with placebo, reductions in pain were reported after injections of sodium hyaluronate (short [3·91, 3·54-4·28, p<0·0001], intermediate [2·89, 2·58-3·20, p<0·0001], and long [3·91, 3·55-4·28, p<0·0001] terms), botulinum toxin (short term [1·23, 0·67-1·78, p<0·0001]), and prolotherapy (intermediate term [2·62, 1·36-3·88, p<0·0001]) for treatment of lateral epicondylalgia. Lauromacrogol (polidocanol), aprotinin, and platelet-rich plasma were not more efficacious than was placebo for Achilles tendinopathy, while prolotherapy was not more effective than was eccentric exercise. Despite the effectiveness of corticosteroid injections in the short term, non-corticosteroid injections might be of benefit for long-term treatment of lateral epicondylalgia. However, response to injection should not be generalised because of variation in effect between sites of tendinopathy. None. Copyright © 2010 Elsevier Ltd. All rights reserved.

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Safety of celecoxib in patients with ulcerative colitis in remission: a randomized, placebo-controlled, pilot study.

Jørn Brynskov, Alexander Bloom, Mark L Robbins … (2006)

The safety of selective cyclooxygenase-2 inhibitors in patients with ulcerative colitis in remission is unknown. We performed a placebo-controlled pilot trial to evaluate the safety of celecoxib in patients with ulcerative colitis in remission who had a present or past history of nonspecific arthritis, arthralgia, or other condition amenable to nonsteroidal anti-inflammatory drug therapy. A total of 222 patients with ulcerative colitis in remission were randomized to receive oral celecoxib 200 mg or placebo twice daily for 14 days. Remission was defined as a total Mayo Clinic score of 2 points or less and an endoscopic score of 1 point or less. Disease exacerbation was defined as a total Mayo Clinic score of 5 points or more and an increase in the endoscopic score of 1 point or more. The primary analysis was disease exacerbation through day 14 among patients who underwent randomization, had at least 1 dose of study drug, and had both endoscopy and Mayo Clinic disease activity index scores at the baseline and final assessments. Three percent of patients in the celecoxib group experienced disease exacerbation through day 14, as compared with 4% in the placebo group (P = .719). Eleven percent of patients in each group experienced a bowel-related adverse event (P > .20). Therapy with celecoxib for up to 14 days did not have a greater relapse rate than placebo in patients with ulcerative colitis in remission who had a present or past history of nonspecific arthritis, arthralgia, or other condition amenable to nonsteroidal anti-inflammatory drug therapy.

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Seronegative spondyloarthritis.

Jane Zochling, Emma Smith (2010)

Seronegative spondyloarthritis (SpA) is a group of inflammatory rheumatic diseases with common clinical and aetiological features, including axial and peripheral inflammatory arthritis, enthesitis, extra-articular manifestations and a close link to the presence of the human leucocyte antigen (HLA)-B27 epitope. Ankylosing spondylitis is the most common of the SpA diseases, with prevalence in the Caucasian population ranging between 0.15% and 1.8%, generally higher in populations with a higher background prevalence of HLA-B27 positivity. Incidence has been estimated between 0.49 (Japan) and 10 (Norway) per 100,000. The prevalence of psoriatic arthritis ranges from 0.02% to 0.2%, and the incidence in the normal population is 7.2 per 100,000 per year. In patients with existing psoriasis, the prevalence of psoriatic arthritis rises to 6-42%. The prevalence of reactive arthritis is dependent on the background incidence of gastrointestinal or genitourinary infections; incidence has been described as up to 30-40 per 100,000. SpA symptoms are present in up to 50% of patients with inflammatory bowel disease. 2011 Elsevier Ltd. All rights reserved.

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Author and article information

Journal

Title: Arthritis & Rheumatology

Abbreviated Title: Arthritis & Rheumatology

Publisher: Wiley

ISSN: 23265191

Publication date Created: February 2016

Publication date (Print): February 2016

Publication date (Electronic): September 24 2015

Volume: 68

Issue: 2

Pages: 282-298

Affiliations

[1 ]National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH; Bethesda Maryland

[2 ]Oregon Health & Science University; Portland

[3 ]American University of Beirut, Beirut, Lebanon, and McMaster University; Hamilton Ontario Canada

[4 ]University of California; San Francisco

[5 ]Brigham and Women's Hospital; Boston Massachusetts

[6 ]University of Wisconsin; Madison

[7 ]Arthritis and Rheumatism Associates; Washington DC

[8 ]Children's Hospital of Philadelphia and University of Pennsylvania; Philadelphia

[9 ]University of Toronto; Toronto Ontario Canada

[10 ]University of Mississippi Medical Center; Jackson

[11 ]University of Alberta; Edmonton Alberta Canada

[12 ]American College of Rheumatology; Atlanta Georgia

[13 ]Vancouver; British Columbia Canada

[14 ]Hospital for Special Surgery; New York New York

[15 ]Cedars-Sinai Medical Center; Beverly Hills California

[16 ]VA Long Beach Medical Center, Long Beach, California, and University of California; Irvine

[17 ]Oregon Health & Science University and Legacy Devers Eye Institute; Portland

[18 ]University of Massachusetts; Worcester

[19 ]University of Ghent; Ghent Belgium

[20 ]University of California; Los Angeles

[21 ]University of Texas Health Sciences Center at Houston

[22 ]Denver VA Medical Center, Denver, Colorado, and University of Colorado; Aurora

Article

DOI: 10.1002/art.39298

PMC ID: 5123840

PubMed ID: 26401991

SO-VID: 259939ea-5e98-4dd9-b7e7-adeb70b62118

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http://doi.wiley.com/10.1002/tdm_license_1.1

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American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis : ACR/SAA/Spartan Treatment Recommendations in as

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Model Reduction of Parametrized Systems 2015

Most cited references 11

Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.

Safety of celecoxib in patients with ulcerative colitis in remission: a randomized, placebo-controlled, pilot study.

Seronegative spondyloarthritis.

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