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Joint Bone Spine
Volume 73, n° 5
pages 547-553 (octobre 2006)
Doi : 10.1016/j.jbspin.2006.02.005
Received : 28 September 2005 ;  accepted : 14 February 2006
TNF antagonist therapy in ankylosing spondylitis and psoriatic arthritis: recommendations of the French Society for Rheumatology

Thao Pham a, , Francis Guillemin b, Pascal Claudepierre c, Mathieu Luc a, Corinne Miceli-Richard d, Bruno Fautrel e, Michel de Bandt f, Maxime Breban g, Philippe Goupille h, Jean-Francis Maillefert i, Charles Masson j, Alain Saraux k, Thierry Schaeverbeke l, Daniel Wendling m, Xavier Mariette d, Bernard Combe n

[pour le Club Rhumatismes et Inflammation (CRI) et la Société Française de Rhumatologie (SFR)]

a Service de Rhumatologie, CHU de la Conception, 147, bd Baille, 13005 Marseille, France 
b Ecole de Santé Publique, Faculté de Médecine, Vandoeuvre-lès-Nancy, France 
c Service de Rhumatologie, CHU de Henri-Mondor, Créteil, France 
d Service de Rhumatologie, CHU de Kremlin-Bicêtre, Le Kremlin Bicêtre, France 
e Service de Rhumatologie, CHU de Pitié Salpetrière, Paris, France 
f Service de Rhumatologie, CHI Robert Ballanger, Aulnay-sous-Bois, France 
g Service de Rhumatologie, CHU de Ambroise Paré, Boulogne-Billancourt, France 
h Service de Rhumatologie, CHU de Tours, Tours, France 
i Service de Rhumatologie, CHU de Dijon, Dijon, France 
j Service de Rhumatologie, CHU de Angers, Angers, France 
k Service de Rhumatologie, CHU de La Cavale Blanche, Brest, France 
l Service de Rhumatologie, CHU de Pellegrin, Bordeaux, France 
m Service de Rhumatologie, CHU de Jean Minjoz, Besançon, France 
n Service d'Immuno-Rhumatologie, CHU de Lapeyronie, Montpellier, France 

Corresponding author.

To develop recommendations for TNF antagonist therapy in patients with spondyloarthropathies.


The Delphi consensus procedure was used to select questions, to which evidence-based answers were sought in the literature. Expert opinion was used when needed to estimate the risks and benefits of TNF antagonists. TNF antagonists exert potent antiinflammatory effects but fail to provide a definitive cure.


Recommendations were developed for patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA). The following criteria for TNF antagonist therapy were selected: definitive diagnosis of AS or PsA, active disease for at least 4 consecutive weeks documented during two physician visits, overall physician's assessment of disease activity4/10 and BASDAI4/10 in axial disease or at least three tender and swollen joints in peripheral disease, failure to respond adequately to at least three nonsteroidal antiinflammatory drugs given in optimal dosages for at least 3 months in axial disease or at least one disease-modifying antirheumatic drug (methotrexate, leflunomide, sulfasalazine) for at least 4 months, with local glucocorticoid injections if appropriate, in peripheral disease. Effectiveness and safety should be evaluated by a rheumatologist. The frequency of monitoring depends on the drug. Lack of effectiveness should be defined as inadequate improvement after 6-12 weeks, with a less than two-point decrease in the BASDAI in axial disease or a less than 30% decrease in the tender and swollen joint counts in peripheral disease.


These clinical practice recommendations should help rheumatologists in their everyday decisions regarding the use of TNF antagonist therapy in patients with AS or PsA.

The full text of this article is available in PDF format.

Keywords : TNF, Ankylosing spondylitis, Psoriatic arthritis, Recommendations, Guidelines, Spondylarthropathy

© 2006  Published by Elsevier Masson SAS.