[Bechterew disease--a consensus on diagnosis and treatment]

Abstract

Background: New treatment alternatives have improved the prospects for patients with ankylosing spondylitis.

Material and methods: Experts from 10 countries developed and voted for 9 questions regarding diagnostics, monitoring and pharmacological treatment (except biological) of ankylosing spondylitis. The Norwegian group added two questions on non-pharmacological treatment. A thorough literature search was performed. 39 experts attended a Norwegian consensus meeting where they developed and voted for the final recommendations for treatment of ankylosing spondylitis.

Results: Statements are generally based on limited evidence, but are highly supported by the experts. Important diagnostic factors are persistent inflammatory back pain in individuals under 40 years, HLA-B27-tissue, effect of NSAIDs, peripheral arthritis, morning stiffness and elevated acute phase reactants. MRI of sacroiliac joints is important for early diagnosis, but abnormalities must be verified by conventional radiographs. Long-term follow-up should include measures of inflammation, pain and function. NSAIDs and local corticosteroids are first line drugs for treatment of enthesitis. NSAIDs/coxibs are recommended as flexible on-demand-regimens. Patients should be encouraged to adapt exercising to disease severity and individual needs.

Interpretation: Consensus-based processes among experts may give valuable contributions to the management of ankylosing spondylitis.