Which patients with ankylosing spondylitis should be treated with TNF inhibiting therapy?

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Ann Rheum Dis. 2004 May;63(5):530-4.

Which patients with ankylosing spondylitis should be treated with tumour

necrosis factor inhibiting therapy? A survey among Dutch

rheumatologists.

Landewe R, Rump B, van der Heijde D, van der Linden S.

University Hospital Maastricht, Department of Internal

Medicine/Rheumatology, Maastricht, Netherlands. rlan@...

AIM: To determine the criteria considered important by Dutch

rheumatologists in judging whether a patient with ankylosing spondylitis

should start tumour necrosis factor (TNF) blocking therapy. METHODS: 19

Dutch rheumatologists were asked to prioritise various demographic and

clinical features for their importance in judging whether a patient

should be treated with TNF blocking therapy. In addition, nine Dutch

physicians who had referred patients with ankylosing spondylitis for

inclusion in an ongoing long term observational study (OASIS) were asked

to determine on the basis of case record review for each of their

patients whether or not TNF blocking therapy would be considered

appropriate. RESULTS: The variables considered most important were: rate

of development of functional impairment; physician's global assessment

of current disease activity; physician's global assessment of cumulative

disease activity; presence of hip arthritis; physician's global

assessment of disease severity. Analysis of the OASIS data (79 patients)

showed that patients in whom TNF blocking therapy was considered

justified (n = 24; 30%) differed significantly from those in whom it was

not considered justified in: patient reported disease activity;

functional impairment; spinal mobility; radiographic damage score.

Multivariate analysis showed that male sex, function, and radiographic

damage were the only independent determinants of a decision to start TNF

blocking drugs.

CONCLUSIONS: Physicians reported that disease activity, function, and

severity were critically important in judging whether to start TNF

blocking therapy. In practice, they based their decision more on

severity than on activity. They were able to select patients with a high

level of radiographic damage, which suggests that this feature captures

other domains such as disease activity, spinal mobility, and function.

PMID: 15082483

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