Skip to Main Content

ANKYLOSING SPONDYLITIS AND SPONDYLOARTHRITIS

Population

  • –Adults with ankylosing spondylitis (AS) or nonradiographic spondyloarthritis.

Recommendations

ACR/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015

  • Recommendations for treatment of ankylosing spondylitis

    • Scheduled NSAIDs.

    • Tumor necrosis factor inhibitor (TNFi) therapy.

    • Recommends addition of slow-acting anti-rheumatic drugs when TNFi medications contraindicated.

    • Local parenteral corticosteroids for active sacroiliitis, active enthesitis, or peripheral arthritis for symptoms refractory to NSAIDs.

    • Avoid systemic corticosteroid use.

    • Refer to an ophthalmologist for concomitant iritis.

    • Recommend TNFi monoclonal antibody therapy for AS with inflammatory bowel disease.

    • Physical therapy program.

    • Screen for fall risk, osteoporosis.

  • Recommendations for treatment of nonradiographic axial spondyloarthritis

    • NSAIDs.

    • Tumor Necrosis Factor inhibitor (TNFi) therapy.

Source

  • –Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheumatol. 2016;68(2):282-298.

ATOPIC DERMATITIS (AD)

Population

  • –Adults and children.

Recommendations

AAD 2014

  • –Generous application of skin moisturizers after bathing.

  • –Recommend limited use of hypoallergenic nonsoap cleansers.

  • –Consider wet-wrap therapy with topical corticosteroids for moderate-to-severe AD during flares.

  • –Twice-daily topical corticosteroids are the first-line therapy for AD.

  • –Topical calcineurin inhibitors (tacrolimus or pimecrolimus) can be used for maintenance AD therapy.

  • –Recommend against topical antihistamine therapy for AD.

  • –Phototherapy is second-line treatment for refractory cases.

  • –Consider systemic immunomodulating agents for severe cases that are refractory to topical agents and phototherapy.

Sources

Comment

  1. Systemic immunomodulating agents that have been studied in AD are azathioprine, cyclosporine, or methotrexate.

BACK PAIN, LOW

Population

  • –Adults.

Recommendations

ACP 2017

  • –Consider nonpharmacologic treatments for acute or subacute low-back pain including superficial heat, massage, acupuncture, or spinal manipulation.

  • –If pharmacologic treatments needed, start with NSAIDs or skeletal muscle relaxants.

  • –For chronic low back pain, start a trial of nonpharmacologic treatments including exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, biofeedback, cognitive behavioral therapy, or spinal manipulation.

  • –For persistent chronic low-back pain, pharmacologic therapy with NSAIDs as first-line therapy and tramadol or duloxetine as second-line therapy.

  • –Use opiates for chronic low-back pain only if patients have failed all other therapies and only if the potential benefits outweigh the risks of dependency, addiction, overdose, and misuse.

Sources

NICE 2009

...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.