In 2013 the first recommendations for treating spondyloarthritis to target (T2T) were published. These followed the reasoning for the T2T recommendations for rheumatoid arthritis. Although the systematic literature review at that time did not provide evidence to support the recommendations, five overarching principles and 11 recommendations were formulated. There were 9 commen recommendations for axial SpA, peripheral SpA and psoriatic arthritis and 2 additional recommendations for each subgroup specifically. In 2017 the T2T working group met again to update the recommendations. This was based on an updated systematic literature review. Data had been published that there is indeed a clear link between inflammation and subsequent longterm outcomes, which is the basis for the T2T principles.
SpA is characterised by musculoskeletal signs and symptoms (arthritis, enthesitis, dactylitis, axial disease) but also extra-articular manifestations (psoriasis, inflammatory bowel disease, anterior uveitis) are important manifestations. Moreover, comborbidities (such as osteoporosis, cardiovascular disease). All these manifestations are taken into account in the formulation of the recommendations.
The overarching principles were kept largely identical. Some changes in the wording were made for a better understanding, but no fundamental changes were made. A total of 11 recommendations were formulated. These are now for all subgroups of SpA and no specific recommendations are proposed. In principle, the treatment target is remission or inactive disease of musculoskeletal and extra-articulaur manifestations, and the target should be individualised. It is important that remission/inactive disease should be based on a combination of clinical and laboratory parameters, and disease activity should be measured on the basis of clinical signs and symptoms as well as acute phase reactants. This is important to realise, e.g. in axial SpA as patient reported outcomes only are at best weakly correlated with structural damage. In certain circumstances, low disease activity may be an alternative target. Because of the heterogeneous presentation of SpA, not only the target, but also the assessments should be individualised. Both in the overarching principles and in the recommendation the shared decision between patient and rheumatologist is listed as the basis of the T2T management.
The updated recommendations will be presented.
Disclosure of Interest D. Van Der Heijde Consultant for: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, UCB, Employee of: Imaging Rheumatology