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      2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

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          Abstract

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

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          Most cited references29

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          Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis

          Tofacitinib, an oral, small-molecule Janus kinase inhibitor, was shown to have potential efficacy as induction therapy for ulcerative colitis in a phase 2 trial. We further evaluated the efficacy of tofacitinib as induction and maintenance therapy.
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            ACG Clinical Guideline: Management of Crohn’s Disease in Adults

            Crohn's disease is an idiopathic inflammatory disorder of unknown etiology with genetic, immunologic, and environmental influences. The incidence of Crohn's disease has steadily increased over the past several decades. The diagnosis and treatment of patients with Crohn's disease has evolved since the last practice guideline was published. These guidelines represent the official practice recommendations of the American College of Gastroenterology and were developed under the auspices of the Practice Parameters Committee for the management of adult patients with Crohn's disease. These guidelines are established for clinical practice with the intent of suggesting preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When exercising clinical judgment, health-care providers should incorporate this guideline along with patient's needs, desires, and their values in order to fully and appropriately care for patients with Crohn's disease. This guideline is intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. To evaluate the level of evidence and strength of recommendations, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.
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              Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee.

              Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifically valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identified as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specific problem. Guidelines are intended to be flexible and must be distinguished from standards of care, which are inflexible and rarely violated. Given the wide range of specifics in any health-care problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the field, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case-control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.
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                Author and article information

                Journal
                Arthritis & Rheumatology
                Arthritis Rheumatol
                Wiley
                2326-5191
                2326-5205
                August 22 2019
                August 22 2019
                Affiliations
                [1 ]National Institute of Arthritis and Musculoskeletal and Skin Diseases Bethesda Maryland
                [2 ]Oregon Health & Science University Portland
                [3 ]University of California San Francisco
                [4 ]Boston University School of Medicine Boston Massachusetts
                [5 ]University of California Los Angeles
                [6 ]Case Western Reserve University Cleveland Ohio
                [7 ]University of TorontoKrembil Research InstituteToronto Western Hospital Toronto Ontario Canada
                [8 ]Arthritis & Rheumatism Associates Washington DC
                [9 ]Columbia University Medical Center New York New York
                [10 ]VA West Los Angeles Medical Center Los Angeles California
                [11 ]Arthritis and Rheumatism Associates Wheaton Maryland
                [12 ]University of Mississippi Medical Center Jackson
                [13 ]University of Washington Seattle
                [14 ]Seattle Washington
                [15 ]Pianin and Associates, PC Phoenix Arizona
                [16 ]American College of Rheumatology Atlanta Georgia
                [17 ]ECRI Institute Plymouth Meeting Pennsylvania
                [18 ]University of Alberta Edmonton Alberta Canada
                [19 ]Rocky Mountain Regional VA Medical Center and University of Colorado Aurora
                Article
                10.1002/art.41042
                6764882
                31436036
                7c0d0c16-f440-4fb0-868f-a690a46074e7
                © 2019

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

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