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Randomised controlled trials (RCTs) and clinical controlled trials were assessed for efficacy and safety, while observational studies with a comparator were assessed for safety. All relevant efficacy and safety outcomes were included. Study heterogeneity precluded data pooling. If possible, Cohen's effect size was calculated for non-pharmacological treatments. In total, 45 papers and 2 abstracts were included. Studies on non-pharmacological treatments were very heterogeneous but overall confirmed a benefit for regular exercises, with small improvements in disease activity, function and spinal mobility. New studies on non-steroidal anti-inflammatory drugs (NSAIDs) confirmed their efficacy and new safety signals were not found. NSAIDs used continuously compared with on-demand did not reduce the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) mean change over 2\u2005years in patients with ankylosing spondylitis with normal C reactive protein (CRP; \u22645\u2005mg\/L) (1 \u2018negative\u2019 RCT (0.9 vs 0.8; p=0.62)), while for patients with high CRP, conflicting results were found (1 \u2018positive\u2019 RCT (0.2 vs 1.7; p=0.003), 1 \u2018negative\u2019 RCT (1.68 vs 0.96; p=0.28)). No new trials were found for conventional synthetic DMARDs (csDMARDs). Short-term high-dose systemic glucocorticoids showed limited efficacy. Regular exercises may improve several outcomes. Efficacy and safety of NSAIDs in axSpA are confirmed. Glucocorticoids are not proven to be effective in axSpA and new data on csDMARDs are lacking.<\/jats:p>","DOI":"10.1136\/rmdopen-2016-000397","type":"journal-article","created":{"date-parts":[[2017,1,27]],"date-time":"2017-01-27T21:25:20Z","timestamp":1485552320000},"page":"e000397","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":83,"title":["Efficacy and safety of non-pharmacological and non-biological pharmacological treatment: a systematic literature review informing the 2016 update of the ASAS\/EULAR recommendations for the management of axial spondyloarthritis"],"prefix":"10.1136","volume":"3","author":[{"given":"Andrea","family":"Regel","sequence":"first","affiliation":[{"name":"Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1954-0229","authenticated-orcid":false,"given":"Alexandre","family":"Sepriano","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9475-9362","authenticated-orcid":false,"given":"Xenofon","family":"Baraliakos","sequence":"additional","affiliation":[{"name":"Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00e9sir\u00e9e","family":"van der Heijde","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Braun","sequence":"additional","affiliation":[{"name":"Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Landew\u00e9","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Zuyderland Medical Center, Heerlen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Van den Bosch","sequence":"additional","affiliation":[{"name":"Ghent University Hospital, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Falzon","sequence":"additional","affiliation":[{"name":"Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Ramiro","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,1,27]]},"reference":[{"key":"2025090313313127000_3.1.e000397.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2005.041137"},{"key":"2025090313313127000_3.1.e000397.2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.151027"},{"key":"2025090313313127000_3.1.e000397.3","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes026"},{"key":"2025090313313127000_3.1.e000397.4","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes066"},{"key":"2025090313313127000_3.1.e000397.5","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.151563"},{"key":"2025090313313127000_3.1.e000397.6","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.108233"},{"key":"2025090313313127000_3.1.e000397.7","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204317"},{"key":"2025090313313127000_3.1.e000397.8","doi-asserted-by":"crossref","unstructured":"Sepriano A , Regel A , van der Heijde D , et al . 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