title: Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force.
abstract: BACKGROUND
  Therapeutic targets have been defined for diseases like diabetes, hypertension or rheumatoid arthritis and adhering to them has improved outcomes. Such targets are just emerging for spondyloarthritis (SpA).
  
  
  OBJECTIVE
  To define the treatment target for SpA including ankylosing spondylitis and psoriatic arthritis (PsA) and develop recommendations for achieving the target, including a treat-to-target management strategy.
  
  
  METHODS
  Based on results of a systematic literature review and expert opinion, a task force of expert physicians and patients developed recommendations which were broadly discussed and voted upon in a Delphi-like process. Level of evidence, grade and strength of the recommendations were derived by respective means. The commonalities between axial SpA, peripheral SpA and PsA were discussed in detail.
  
  
  RESULTS
  Although the literature review did not reveal trials comparing a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated the development of recommendations. The group agreed on 5 overarching principles and 11 recommendations; 9 of these recommendations related commonly to the whole spectrum of SpA and PsA, and only 2 were designed separately for axial SpA, peripheral SpA and PsA. The main treatment target, which should be based on a shared decision with the patient, was defined as remission, with the alternative target of low disease activity. Follow-up examinations at regular intervals that depend on the patient's status should safeguard the evolution of disease activity towards the targeted goal. Additional recommendations relate to extra-articular and extramusculoskeletal aspects and other important factors, such as comorbidity. While the level of evidence was generally quite low, the mean strength of recommendation was 9-10 (10: maximum agreement) for all recommendations. A research agenda was formulated.
  
  
  CONCLUSIONS
  The task force defined the treatment target as remission or, alternatively, low disease activity, being aware that the evidence base is not strong and needs to be expanded by future research. These recommendations can inform the various stakeholders about expert opinion that aims for reaching optimal outcomes of SpA.
authors.affiliation: Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, , Vienna, Austria.
authors.forename: Josef S
authors.initials: JS
authors.lastname: Smolen
authors.forename: Jürgen
authors.initials: J
authors.lastname: Braun
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
authors.forename: Oliver
authors.initials: O
authors.lastname: Fitzgerald
authors.forename: Philip
authors.initials: P
authors.lastname: Helliwell
authors.forename: Arthur
authors.initials: A
authors.lastname: Kavanaugh
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.forename: Robert
authors.initials: R
authors.lastname: Landewé
authors.forename: Thomas
authors.initials: T
authors.lastname: Luger
authors.forename: Philip
authors.initials: P
authors.lastname: Mease
authors.forename: Ignazio
authors.initials: I
authors.lastname: Olivieri
authors.forename: John
authors.initials: J
authors.lastname: Reveille
authors.forename: Christopher
authors.initials: C
authors.lastname: Ritchlin
authors.forename: Martin
authors.initials: M
authors.lastname: Rudwaleit
authors.forename: Monika
authors.initials: M
authors.lastname: Schoels
authors.forename: Joachim
authors.initials: J
authors.lastname: Sieper
authors.forename: Martinus de
authors.initials: Md
authors.lastname: Wit
authors.forename: Xenofon
authors.initials: X
authors.lastname: Baraliakos
authors.forename: Neil
authors.initials: N
authors.lastname: Betteridge
authors.forename: Ruben
authors.initials: R
authors.lastname: Burgos-Vargas
authors.forename: Eduardo
authors.initials: E
authors.lastname: Collantes-Estevez
authors.forename: Atul
authors.initials: A
authors.lastname: Deodhar
authors.forename: Dirk
authors.initials: D
authors.lastname: Elewaut
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.forename: Merryn
authors.initials: M
authors.lastname: Jongkees
authors.forename: Mara
authors.initials: M
authors.lastname: Maccarone
authors.forename: Kurt
authors.initials: K
authors.lastname: Redlich
authors.forename: Filip
authors.initials: F
authors.lastname: van den Bosch
authors.forename: James Cheng-Chung
authors.initials: JC
authors.lastname: Wei
authors.forename: Kevin
authors.initials: K
authors.lastname: Winthrop
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D006801:Humans; D012219:Rheumatology / Q000592:standards*; D025241:Spondylarthritis / Q000188:drug therapy*; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*
chemical_list: D018501:Antirheumatic Agents
keywords: Treat-to-target; ankylosing spondylitis; psoriatic arthritis; spondyloarthritis; therapy