title: Treating axial and peripheral spondyloarthritis, including psoriatic arthritis, to target: results of a systematic literature search to support an international treat-to-target recommendation in spondyloarthritis.
abstract: BACKGROUND
  Current recommendations for the management of axial spondyloarthritis (SpA) and psoriatic arthritis are to monitor disease activity and adjust therapy accordingly. However, treatment targets and timeframes of change have not been defined. An international expert panel has been convened to develop 'treat-to-target' recommendations, based on published evidence and expert opinion.
  
  
  OBJECTIVE
  To review evidence on targeted treatment for axial and peripheral SpA, as well as for psoriatic skin disease.
  
  
  METHODS
  We performed a systematic literature search covering Medline, Embase and Cochrane, conference abstracts and studies in http://www.clinicaltrials.gov.
  
  
  RESULTS
  Randomised comparisons of targeted versus routine treatment are lacking. Some studies implemented treatment targets before escalating therapy: in ankylosing spondylitis, most trials used a decrease in Bath Ankylosing Spondylitis Disease Activity Index; in psoriatic arthritis, protocols primarily considered a reduction in swollen and tender joints; in psoriasis, the Modified Psoriasis Severity Score and the Psoriasis Area and Severity Index were used. Complementary evidence correlating these factors with function and radiographic damage at follow-up is sparse and equivocal.
  
  
  CONCLUSIONS
  There is a need for randomised trials that investigate the value of treat-to-target recommendations in SpA and psoriasis. Several trials have used thresholds of disease activity measures to guide treatment decisions. However, evidence on the effect of these data on long-term outcome is scarce. The search data informed the expert committee regarding the formulation of recommendations and a research agenda.
authors.affiliation: 2nd Department of Internal Medicine, Center for Rheumatic Diseases, Hietzing Hospital, , Vienna, Austria.
authors.forename: M M
authors.initials: MM
authors.lastname: Schoels
authors.forename: J
authors.initials: J
authors.lastname: Braun
authors.forename: M
authors.initials: M
authors.lastname: Dougados
authors.forename: P
authors.initials: P
authors.lastname: Emery
authors.forename: O
authors.initials: O
authors.lastname: Fitzgerald
authors.forename: A
authors.initials: A
authors.lastname: Kavanaugh
authors.forename: T K
authors.initials: TK
authors.lastname: Kvien
authors.forename: R
authors.initials: R
authors.lastname: Landewé
authors.forename: T
authors.initials: T
authors.lastname: Luger
authors.forename: P
authors.initials: P
authors.lastname: Mease
authors.forename: I
authors.initials: I
authors.lastname: Olivieri
authors.forename: J
authors.initials: J
authors.lastname: Reveille
authors.forename: C
authors.initials: C
authors.lastname: Ritchlin
authors.forename: M
authors.initials: M
authors.lastname: Rudwaleit
authors.forename: J
authors.initials: J
authors.lastname: Sieper
authors.forename: J S
authors.initials: JS
authors.lastname: Smolen
authors.forename: M de
authors.initials: Md
authors.lastname: Wit
authors.forename: D
authors.initials: D
authors.lastname: van der Heijde
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D038622:Internationality; D016032:Randomized Controlled Trials as Topic; D025241:Spondylarthritis / Q000188:drug therapy*
chemical_list: D018501:Antirheumatic Agents
keywords: Ankylosing Spondylitis; Psoriatic Arthritis; Spondyloarthritis; Treatment