How useful are international recommendations to my clinical practice?
Read our key takeaways from the 2022 ASAS-EULAR recommendations for the management of axSpA, presented as part of Dr Sofia Ramiro's workshop at UCB Summit 2023.
The ASAS-EULAR 2022 Recommendations
ASDAS is a clinically validated index and the most appropriate instrument for measuring disease activity in axSpA.1
- High disease activity should be based on ASDAS ≥2.1 alone; BASDAI ≥4 should only be used if it is impossible to use the ASDAS. When defining high disease activity, in cases of discordance between the two instruments, the ASDAS selects patients with a higher likelihood of response to treatment1
- Specific cut-offs have been validated for the ASDAS to define disease activity states and improvement and worsening criteria. A difference of ≥1.1 after at least 12 weeks of treatment should be used to determine whether a patient can continue treatment1
- Treatment failure should prompt re-evaluation of the diagnosis and consideration of comorbidities. If active axSpA is confirmed, switching to another b/tsDMARD treatment is recommended1
Barriers to the Implementation of Recommendations
Identifying barriers and solutions to implementing recommendations is important.2
- Sometimes barriers to implementing recommendations may be related to the clinician’s knowledge, attitude or behaviour. However, often there are also external barriers, such as a lack of time or resources, organisational constraints or lack of reimbursement2,3
- These barriers can be overcome using educative, financial, organisational or regulative strategies3
- Strategies may include educational outreach visits, active learning from key opinion leaders and providing decision support systems and reminders3
Conclusions
Clinical recommendations should be used in clinical practice.1
- Dr Ramiro concluded that clinical recommendations are important to improve quality of care, health outcomes and patient safety in daily clinical practice4
- They are evidence-based and can be translated into clinical practice.1 As such, patients following recommendations achieve better clinical outcomes than those who take prescribed biologics but whose clinician is not following recommendations5
- Recommendations only reflect the average patient, and each patient is an individual. Deviation from recommendations is sometimes appropriate, where there is an evidence-based justification1,4
ASDAS: Ankylosing Spondylitis Disease Activity Score; ASAS: Assessment of SpondyloArthritis international Society; axSpA: axial spondyloarthritis; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; b/tsDMARD: biological/targeted synthetic disease-modifying antirheumatic drug.
1. Ramiro S et al. Ann Rheum Dis. 2023;82(1):19–34. 2. Cabana MD et al. JAMA. 1999;282(15):1458–1465. 3. Fischer F et al. Healthcare (Basel). 2016;4(3):36. 4. Woolf SH et al. BMJ. 1999;318(7182):527–530. 5. López-Medina C et al. Rheumatology (Oxford). 2018;57(5):880–890.