What are the American College of Rheumatology guidelines for assessment of ankylosing spondylitis (AS) disease activity, imaging, and screening?

Updated: Feb 02, 2021
  • Author: Lawrence H Brent, MD; Chief Editor: Herbert S Diamond, MD  more...
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Assessment of disease activity, imaging, and screening:

  • Conditionally recommend the monitoring of a validated AS disease activity measure at regular intervals
  • Conditionally recommend regular-interval monitoring of C-reactive protein (CRP) concentrations or erythrocyte sedimentation rate (ESR) over usual care without regular CRP or ESR monitoring
  • In adults with active AS, conditionally recommend against using a treat-to-target strategy using a target Ankylosing Spondylitis Disease Activity Score (ASDAS) of < 1.3 (or 2.1) over a treatment strategy based on physician assessment
  • Conditionally recommend screening for osteopenia/osteoporosis with dual-energy x-ray absorptiometry (DXA) scan over no screening
  • In adults with syndesmophytes or spinal fusion, conditionally recommend screening for osteoporosis/osteopenia with DXA scan of the spine as well as the hips, compared with DXA scan solely of the hip or other non-spine sites
  • Strongly recommend against screening for cardiac conduction defects with electrocardiograms
  • Strongly recommend against screening for valvular heart disease with echocardiograms
  • In adults with AS of unclear activity while on a biologic, conditionally recommend obtaining a spinal or pelvis MRI to assess activity
  • In adults with stable AS, conditionally recommend against obtaining a spinal or pelvis MRI to confirm inactivity
  • In adults with active or stable AS on any treatment, conditionally recommend against obtaining repeat spine radiographs at a scheduled interval (eg, every 2 years) as a standard approach

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