J Rheum Dis.  2023 Jul;30(3):151-169. 10.4078/jrd.2023.0025.

Korean treatment recommendations for patients with axial spondyloarthritis

• Seo MR
• Yeo J
• Park JW
• Lee YA
• Lee JH
• Kang EH
• Ji SM
• Kwon SR
• Kim SK
• Kim TJ
• Kim TH
• Kim HW
• Park MC
• Shin K
• Lee SH
• Lee EY
• Cha HS
• Shim SC
• Yoon Y
• Lee SH
• Lim JH
• Baek HJ
• on behalf of the Korean Society of Spondyloarthritis Research

• KMID: 2543942
• DOI: http://doi.org/10.4078/jrd.2023.0025

Abstract

We aimed to develop evidence-based recommendations for treating axial spondylarthritis (axSpA) in Korea. The development committee was constructed, key clinical questions were determined, and the evidence was searched through online databases including MEDLINE, Embase, Cochrane, KoreaMed, and KMbase. Systematic literature reviews were conducted, quality of evidence was determined, and draft recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluations methodology. Recommendations that reached 80% consensus among a voting panel were finalized. Three principles and 21 recommendations were determined. Recommendations 1 and 2 pertain to treatment strategies, regular disease status assessment, and rheumatologist-steered multidisciplinary management. Recommendations 3 and 4 strongly recommend patient education, exercise, and smoking cessation. Recommendations 5~12 address pharmacological treatment of active disease using nonsteroidal anti-inflammatory drugs, glucocorticoids, sulfasalazine, biologics, and Janus kinase inhibitors. Recommendations 13~16 address treatment in stable disease. We suggest against spa and acupuncture as therapies (Recommendation 17). Recommendations 18 and 19 pertain to total hip arthroplasty and spinal surgery. Monitoring of comorbidities and drug toxicities are recommended (Recommendations 20 and 21). Recommendations for axSpA treatment in a Korean context were developed based on comprehensive clinical questions and evidence. These are intended to guide best practice in the treatment of axSpA.

Keyword

Axial spondyloarthritis; Ankylosing spondylitis; Treatment; Recommendations

Figure

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  Fig. 1 Treatment algorithm based on Korean treatment recommendations for patients with axial spondyloarthritis. GC: glucocorticoid, IBD: inflammatory bowel disease, IL-17: interleukin-17, JAK: Janus kinase, NSAID: non-steroidal anti-inflammatory drug, SSZ: sulfasalazine, TNF: tumor necrosis factor.

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