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ANKYLOSING SPONDYLITIS AND SPONDYLOARTHRITIS

Population

  • – Adults with ankylosing spondylitis (AS) or nonradiographic spondyloarthritis.

Recommendations

ACR/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2019

  • Recommendations for treatment of ankylosing spondylitis

    • Scheduled NSAIDs.

    • Tumor necrosis factor inhibitor (TNFi) therapy.

    • Recommends addition of slow-acting antirheumatic drugs when TNFi medications contraindicated.

    • Local parenteral corticosteroids for active sacroiliitis, active enthesitis, or peripheral arthritis for symptoms refractory to NSAIDs.

    • Avoid systemic corticosteroid use.

    • Refer to an ophthalmologist for concomitant iritis.

    • Recommend TNFi monoclonal antibody therapy for AS with inflammatory bowel disease.

    • Physical therapy program.

    • Screen for fall risk, osteoporosis.

  • Recommendations for treatment of nonradiographic axial spondyloarthritis

    • NSAIDs.

    • Tumor Necrosis Factor inhibitor (TNFi) therapy.

Sources

  • – Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheumatol. 2016;68(2):282-298.

  • – rheumatology.org; 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

ATOPIC DERMATITIS (AD)

Population

  • – Adults and children.

Recommendations

AAD 2020

  • – Apply skin moisturizers after bathing with hypoallergenic neutral to low pH non-soap cleansers. No evidence for use of oils.

  • – Consider wet-wrap therapy with topical corticosteroids for moderate-to-severe AD during flares.

  • – Use twice-daily topical corticosteroids as first-line therapy.

  • – Consider topical calcineurin inhibitors (tacrolimus or pimecrolimus) for maintenance therapy.

  • – Consider bleach baths and intranasal mupirocin when signs of secondary bacterial infection.

  • – Do not use topical antihistamine therapy.

  • – Consider phototherapy for acute and chronic AD in both adults and children. NB-UVB is most used due to low-risk profile.

  • – Consider systemic immunomodulating agents for severe cases that are refractory to topical agents and phototherapy such as cyclosporine or methotrexate. Systemic steroids should be avoided except as bridge to another therapy.

  • – Do not use oral antibiotics unless there is clinical evidence of infection.

  • – Do not use skin prick tests or blood tests (eg, radioallergosorbent test) for the routine evaluation of atopic dermatitis.

Sources

  • – aad.org/clinical-quality/guidelines; Atopic dermatitis clinical guideline

  • – American Academy of Dermatology. Choosing Wisely. 2020.

Comment

  1. Skin prick tests and RAST-type blood tests are useful to identify causes of allergic reactions, but not for diagnosing dermatitis or eczema. When testing for suspected allergies is indicated, patch testing with ingredients of products that come in contact with the patient’s skin is recommended.

BACK PAIN, LOW

Population

  • – Adults.

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