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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.

Comment

  1. An update to the 2015 guidelines is expected in 2019.

ATOPIC DERMATITIS (AD)

Population

  • Adults and children.

Recommendations

AAD 2014

  • Generous application of skin moisturizers after bathing.

  • Recommend limited use of hypoallergenic non-soap 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.

AAD 2018

  • Do not use oral antibiotics in atopic dermatitis unless there is clinical evidence of infection.

  • Do not use systemic (oral or injected) corticosteroids for long-term treatment of dermatitis.

  • Do not use skin prick tests or blood tests (eg, radioallergosorbent test) for the routine evaluation of atopic dermatitis.

Source

  • American Academy of Dermatology. Choosing Wisely. 2018.

Comment

  1. Skin prick tests and RAST-type blood tests are useful to identify causes of allergic reactions, but not for diagnosing dermatitis or eczema. When testing for suspected allergies is indicated, patch testing with ingredients of products that come in contact with the patient’s skin is recommended.

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 ...

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