title: Minimal disease activity in axial spondyloarthritis: the need of the hour and a proposal for development.
abstract: Axial spondyloarthritis (axSpA) is a chronic inflammatory condition with articular and extra-articular manifestations. Remission, a state of absence of clinical and imaging signs of disease activity over time, is the goal of management. This review addresses the concept of minimal disease activity (MDA) in axSpA, which is less stringent than remission, and is closer to patient and provider acceptable low disease state.
  
  
  
  Existing axSpA treatments improve physical function and quality of life, and lead to remission in a minority of patients. A consistent MDA state decreases disease progression in rheumatoid arthritis and psoriatic arthritis. We argue a need to develop MDA in axSpA for clinical practice and clinical trials and propose methodology. Considering that MDA will be used in clinical practice, its elements must be easy to collect and cover both musculoskeletal and extra-articular domains. MDA will complement current disease activity measures in axSpA.
  
  
  
  Defining an MDA target in axSpA would provide an outcome measure that is less stringent than remission, and will likely predict function and quality of life. We propose methods to develop MDA in axSpA and that further research be performed to determine if treating to an MDA target in axSpA improves patient outcomes.
authors.affiliation: aOregon Health & Science University, Portland, Oregon bBoston University School of Medicine cVA Boston Healthcare System, Boston, Massachusetts, USA.
authors.forename: Atul A
authors.initials: AA
authors.lastname: Deodhar
authors.forename: Anand
authors.initials: A
authors.lastname: Kumthekar
authors.forename: Maureen
authors.initials: M
authors.lastname: Dubreuil
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D006801:Humans; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D011788:Quality of Life; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000188:drug therapy / Q000503:physiopathology; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents