SURVEY - Which patients with AS should be treated with TNF inhibitors?

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ls of the Rheumatic Diseases 2004;63:530-534

© 2004 by BMJ Publishing Group Ltd & European League Against Rheumatism

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Which patients with ankylosing spondylitis should be treated with tumour

necrosis factor inhibiting therapy? A survey among Dutch rheumatologists

R Landewé, B Rump, D van der Heijde and S van der Linden

University Hospital Maastricht, Department of Internal

Medicine/Rheumatology, Maastricht, Netherlands

Correspondence to:

B M Landewé

Department of Internal Medicine/Rheumatology, PO Box 5800, 6202 AZ

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.

http://ard.bmjjournals.com/cgi/content/abstract/63/5/530

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