Braun J, Zochling J, Märker-Hermann E, Stucki G, Böhm H, Rudwaleit M, Zeidler H, Sieper J
Rheumazentrum-Ruhrgebiet, St. Josefs-Krankenhaus, Landgrafenstrasse 15, 44652, Herne, Deutschland.
Z Rheumatol. 2006 Dec;65(8):728-42. doi: 10.1007/s00393-006-0119-3.
Our aim was to adapt and implement the evidence based recommendations for the management of ankylosing spodylitis (AS) of the "Assessments in AS" (ASAS) International Working Group together with the European League Against Rheumatism (EULAR) within the framework of a competence network (CN) in rheumatology in the German language area.
The ASAS/EULAR project calculated the effective size (ES), rate ratio, number of patients requiring treatment (number needed to treat, NNT) and the incremental cost-effectiveness ratio (ICER). The strength of the recommendations was determined through the evidence level found in the literature, the risk-benefit trade-off and the clinical experience of the experts. The recommendations were recently published in English. All of the centers taking part in the study area Spondyloarthritis (SpA) CN, as well as an additional 35 experts, were sent the English manuscript. All 35 participants were asked to evaluate the ten main management recommendations on a scale from 0 to 10.
The recommendations encompass the use of drugs such as non-steroid anti-inflammatories (NSAR), which, along with conventional NSAR include coxibs and the parallel application of gastroprotectives, so called disease-modifying anti-rheumatic drugs, biologicals, simple analgesics, local and systematic glucocorticoids, non-drug therapies (such as patient training, medical training therapy and physiotherapy), in addition to surgical treatment methods. Moreover, three general recommendations were formulated and a therapy scheme created, taking into consideration the various clinical manifestations. The strength of the ASAS/EULAR recommendations was generally high. There was a marked consensus between the German speaking experts and the international proposal: a mean of 9.13 with relatively low variation between the recommendations.
Ten key recommendations for the treatment of AS were developed. These were strengthened by a systematic search of the literature and by expert consensus. The large group of German speaking experts were largely in agreement with the proposal. This can be seen as a starting point for the dissemination and implementation of the recommendations.
我们的目标是在德语区风湿病学能力网络（CN）的框架内，采用并实施“强直性脊柱炎评估”（ASAS）国际工作组与欧洲抗风湿病联盟（EULAR）共同制定的关于强直性脊柱炎（AS）管理的循证建议。
ASAS/EULAR项目计算了效应量（ES）、率比、所需治疗患者数（需治疗人数，NNT）以及增量成本效益比（ICER）。建议的强度通过文献中的证据水平、风险效益权衡以及专家的临床经验来确定。这些建议最近以英文发表。参与研究区域脊柱关节炎（SpA）CN的所有中心以及另外35位专家都收到了英文手稿。要求所有35名参与者对十条主要管理建议进行0至10分的评分。
这些建议涵盖了多种药物的使用，如非甾体抗炎药（NSAR），其中包括昔布类药物以及传统NSAR与胃保护剂的联合应用，即所谓的改善病情抗风湿药、生物制剂、简单镇痛药、局部和全身糖皮质激素、非药物疗法（如患者培训、医学训练疗法和物理治疗），此外还包括手术治疗方法。此外，还制定了三条一般建议并创建了一个治疗方案，同时考虑了各种临床表现。ASAS/EULAR建议的强度总体较高。德语专家与国际建议之间达成了显著共识：平均分为9.13分，各建议之间的差异相对较小。
制定了十条AS治疗的关键建议。这些建议通过系统的文献检索和专家共识得到了加强。大量德语专家在很大程度上与该建议一致。这可被视为这些建议传播和实施的一个起点。
