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Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians’ decision making, without taking out his/her autonomy when prescribing for an individual patient.

Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013.A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed.These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.

Background Efficacy and safety of netakimab (NTK), a humanized anti-interleukin 17A antibody, have been previously established in two phase 2 clinical trials in patients with radiographic axial spondyloarthritis (r-axSpA)1 and psoriasis2. ASTERA is a randomized, double-blind, placebo (PBO)-controlled phase III trial, aimed to demonstrate efficacy and safety of NTK in subjects with r-axSpA (NCT03447704). Objectives To evaluate the effect of NTK on inflammation in spine and sacroiliac joints (SIJ) at Week (Wk) 16 in ongoing ASTERA study in patients with active r-axSpA. Methods 228 eligible adults with active r-axSpA were randomized into 2 study arms (1:1) to receive 120 mg of NTK or PBO, administered as SC injections at Wk 0, 1, 2 and then q2wk through Wk 16. After Wk 16 all patients will start to receive NTK up to week 52. Inflammation in spine and SIJ was assessed with magnetic resonance imaging (MRI) at baseline and Wk 16. The following scoring methods were used: the Berlin spine score (derived from Ankylosing Spondylitis Spine MRI Activity (ASspi-MRI-a) Score for spine assessment and the SPARCC score for SIJ assessment. All images were evaluated by central reader, blinded to treatment. Results Both arms were comparable in the Berlin spine score (4.18 ± 4.58 in NTK arm vs. 4.19 ± 4.32 in PBO arm) and the SPARCC score (5.67 ± 8.33 in NTK arm vs. 5.23 ± 7.86 in PBO arm) at baseline (p≥0.05). Data analysis at Wk16 revealed that NTK arm achieved significant decline in bone marrow edema in direct comparison with PBO arm: by Wk 16 the mean change from baseline in the Berlin spine score was -2.16 ± 2.87 in NTK arm vs. -0.30 ± 1.55 in PBO arm (p Conclusion: the treatment with NTK at a dose 120 mg leads to improvement in spine and SIJ inflammation in patients with active r-axSpA by Wk16, as compared with PBO. References [1] Mazurov V, Erdes S, Kunder E, et al.: OP0028|Efficacy and safety of BCD-085, a novel il-17 inhibitor, in ankylosing spondylitis. Results of phase 2 clinical study. Ann Rheum Dis2018; 77: A64. [2] Samtsov A, Khairutdinov V, Bakulev A, et al.: Efficacy and Safety of BCD-085, a Novel Interleukin-17 Inhibitor. Results of Phase II Clinical Trial in Patients with Moderate-to-Severe Plaque Psoriasis. Vestn Dermatol Venerol 2017; 0(5):52-63. Disclosure of Interests Alexander Smirnov: None declared, Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: paiment from Pfizer, Novartis, Abbvie, Biocad, Selgene, MSD, Sanofy does not exceed 10 000 euros, V Mazurov Grant/research support from: JSC BIOCAD, Shandor Erdes Grant/research support from: JSC BIOCAD, Speakers bureau: JSC BIOCAD, Tatiana Dubinina: None declared, Olga Nesmeyanova Grant/research support from: JSC BIOCAD, Elena Ilivanova Grant/research support from: JSC BIOCAD, Alena Kundzer: None declared, Nikolaj Soroka: None declared, Anna Eremeeva Grant/research support from: JSC BIOCAD, Ekaterina Chernyaeva Employee of: JSC BIOCAD, Roman Ivanov Employee of: JSC BIOCAD

Objectives To describe the clinical characteristics and the relations with disease activity, functional status, and syndesmophytes formation in patients with axial spondyloarthritis (AxSpA) by categorizing them into different groups. Methods One hundred and sixty three patients with AxSpA were recruited. Clinical and blood parameters were collected. Patients were asked to complete the self-assessment questionnaires, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI). Spinal mobility was measured according to Bath Ankylosing Spondylitis Metrology Index (BASMI). Radiographs of cervical and lumbosacral spine were performed for modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Radiological sacroiliitis was scored for ankylosing spondylitis (AS). Magnetic resonance imaging (MRI) of the sacroiliac (SI) joints was performed for spondyloarthritis research consortium of Canada (SPARCC) MRI inflammation score. Two-way cluster analyses were performed to determine the relationships between the parameters. Results Two cluster models were built using SPARCC scores of different scorers. Results were similar. The group of patients with highest mSASSS (20.33 vs 20.33) and prevalence radiological AS (85% vs 86%) were male patients (75% vs 75%), positive for HLA-B27 (70.0% vs 66.7%), smokers (87.5% vs 97.2%), and higher SPARCC SI joints score (5.32 vs 3.17). Higher BASDAI was observed among female sex. BASMI varies little but the group with highest BASMI (3.60 vs 3.62) also had highest mSASSS (20.33 vs 20.33). Conclusion Our data showed that male smokers with HLA-B27 positivity and SI joints inflammation have more radiological damage and higher prevalence of AS, consistent with known poor prognosis factors.