Expert consensus on diagnosis and treatment of axial spondyloarthritis (2023 edition)

doi:10.3877/cma.j.issn.1674-134X.2023.02.001

Abstract

Abstract:

Axial spondyloarthritis (axial SpA, ax-SpA) is a group of diseases which are characterised by chronic progressive inflammation of the axial joints of spine and the surrounding tissues. In the early stage, an ax-SpA lacks specific symptoms and it is often missed, misdiagnosed or delayed in diagnosis. In the late stage, it causes ankylosing deformities of spine or the affected spinal joints, often leads to a lifelong disability. The Joint Surgery Group of Orthopaedic Branch of the Chinese Medical Association and Physicians Branch of the Chinese Medical Doctor Association assembled an experts editing group to draft a newer version of an expert consensus in order to effectively improve an early and comprehensive diagnosis and treatment of ax-SpA. Base on the 2019 version of expert consensus, comprehensive reviews of international guidelines for the diagnosis and treatment of axial spinal arthritis was conducted, evidences of evidence-based medicine were analysed, and recommendations were concluded through multiple rounds of discussions. A new version of the expert consensus on the diagnosis and treatment of axial spondyloarthritis is hereby created.

Key words: Axial spondyloarthritis, HLA-B27 antigen, Biologic agents, Arthroplasty, Spinal fusion, Consensus

Joint Surgery Group of Orthopaedic Branch of Chinese Medical Association, Sports Medicine Physicians Branch of the Chinese Medical Doctor Association, Changhai Hospital Affiliated to Naval Military Medical University. Expert consensus on diagnosis and treatment of axial spondyloarthritis (2023 edition)[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(02): 151-160.

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References 64

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慢性腰背痛≥3月、且年龄≤45岁
	+
骶髂关节影像学改变^*	或	HLA-B27阳性+
+1个以上SpA特征	或	其他2个以上SpA特征
SpA特征
炎性腰背痛
外周关节炎
指/趾炎
附着点炎
脊柱关节炎家族史
非甾体类药物有效
虹膜睫状体炎
银屑病
炎症性肠病(Crohn’s病/溃疡性结肠炎)
HLA-B27阳性
C反应蛋白升高

慢性腰背痛≥3月、且年龄≤45岁
	+
骶髂关节影像学改变^*	或	HLA-B27阳性+
+1个以上SpA特征	或	其他2个以上SpA特征
SpA特征
炎性腰背痛
外周关节炎
指/趾炎
附着点炎
脊柱关节炎家族史
非甾体类药物有效
虹膜睫状体炎
银屑病
炎症性肠病(Crohn’s病/溃疡性结肠炎)
HLA-B27阳性
C反应蛋白升高

非手术治疗	一线治疗	非药物治疗(功能锻炼、物理治疗等)
		非甾体类抗炎镇痛药
		肿瘤坏死因子拮抗剂(有条件推荐)
	二线治疗	生物制剂：肿瘤坏死因子拮抗剂或白介素17抑制剂
	特殊情况的附加治疗	DMARDs药物、皮质类固醇药物、其他镇痛药物、抗生素等
手术治疗		颈胸段矫形
		胸腰段矫形
		关节置换术

非手术治疗	一线治疗	非药物治疗(功能锻炼、物理治疗等)
		非甾体类抗炎镇痛药
		肿瘤坏死因子拮抗剂(有条件推荐)
	二线治疗	生物制剂：肿瘤坏死因子拮抗剂或白介素17抑制剂
	特殊情况的附加治疗	DMARDs药物、皮质类固醇药物、其他镇痛药物、抗生素等
手术治疗		颈胸段矫形
		胸腰段矫形
		关节置换术

药物	围受孕期可用	妊娠早期可用	妊娠中期/晚期可用	哺乳期可用	父亲可用
英夫利昔单抗	是	是	妊娠16周停药	是^*	是^*
依那西普	是	是	妊娠中期可用晚期不用	是^*	是^*
阿达木单抗	是	是	妊娠中期可用晚期不用	是^*	是^*
赛妥珠单抗	是	是	是^*	是^*	无数据
戈利木单抗	无数据	无数据	无数据	无数据	无数据

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