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Use of Anti-TNF Blockers Varies for Ankylosing Spondylitis

Worldwide, treatment criteria disagree with international standards and vary across nations

WEDNESDAY, Dec. 20 (HealthDay News) -- Although rheumatologists often want to use tumor necrosis factor (TNF)-blocking drugs in patients with ankylosing spondylitis, their criteria for starting anti-TNF treatment in such patients frequently disagree with the international Assessment in Ankylosing Spondylitis (ASAS) group's recommendations, according to a report in the December issue of the Annals of the Rheumatic Diseases.

Desiree van der Heijde, M.D., of University Hospital Maastricht in the Netherlands, and colleagues collected data from 145 rheumatologists in 10 countries treating 1,207 patients with ankylosing spondylitis. The investigators determined if the patients were candidates for anti-TNF treatment and whether these decisions correlated with the ASAS guidelines.

Rheumatologists said they would start TNF-blockers in 49.3 percent of patients (range: 37.2 percent Canada; 78.3 percent Australia), including those with high clinical disease activity, worse function and more sick leave. For all candidates, 40 percent did not satisfy ASAS guidelines for NSAID use or the Bath Ankylosing Spondylitis Disease Activity Index. Rapid radiographic progression was the only important objective measure cited in the decision to start anti-TNF treatment.

"Rheumatologists wanted to initiate TNF-blocking drugs in roughly half of the patients with ankylosing spondylitis. However, there was a wide variation across countries and doctors. Rheumatologists considered both disease activity and severity to be determinants of starting TNF blockers, but their decision was often in disagreement with ASAS recommendations," the authors conclude.

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