2025 Consensus-based recommendations for the referral, diagnosis, monitoring, and management of axial spondyloarthritis in the Arabian Gulf countries
Bibliographic record
Abstract
BACKGROUND: Standardized recommendations for managing axial spondyloarthritis (axSpA) in the context of the Arabian Gulf region are currently limited. OBJECTIVE: We aimed to develop evidence-based consensus recommendations for the referral, diagnosis, monitoring, and management of axSpA patients in the Arabian Gulf countries. METHOD: A task force of seven expert rheumatologists from Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates, along with an advisor, drafted recommendations regarding axSpA patient care based on a systematic literature review (PROSPERO CRD42023403697) of PubMed, Medline, and Cochrane databases. Consensus required a level of agreement ≥70%. Patient research partners and rheumatologists from the region externally validated the statements. RESULTS: Six overarching principles and 21 recommendations, tailored to the needs of the region, were developed. Key principles discussed timely referral to rheumatologists, the diagnostic utility of HLA-B27, shared decision-making, and multidisciplinary management combining non-pharmacological and pharmacological treatment. Training rheumatologists and radiologists on imaging is recommended. MRI of sacroiliac joints is preferred for diagnosis, with spinal MRI or CT of SIJs as alternatives. Cost-effective treatments, such as biosimilars, and alternative routes of drug administration should be prioritized. Treatment failure should prompt reassessment of diagnosis and evaluation of comorbidities. Regularly monitoring cardiovascular risk, pregnancy planning, disease activity monitoring during pregnancy, and use of electronic patient-reported outcome measures for informed decisions are recommended. Regional and national axSpA registries can facilitate evidence generation and enhance management. CONCLUSION: These are the first consensus recommendations tailored to the Arabian Gulf setting, integrating current evidence and regional expertise to optimize the care of axSpA patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.099 | 0.211 |
| Meta-epidemiology (narrow) | 0.003 | 0.003 |
| Meta-epidemiology (broad) | 0.006 | 0.012 |
| Bibliometrics | 0.016 | 0.008 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.007 | 0.006 |
| Open science | 0.012 | 0.009 |
| Research integrity | 0.014 | 0.009 |
| Insufficient payload (model declined to judge) | 0.014 | 0.008 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".