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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
  1. M M Schoels1,
  2. J Braun2,
  3. M Dougados3,
  4. P Emery4,
  5. O Fitzgerald5,
  6. A Kavanaugh6,
  7. T K Kvien7,
  8. R Landewé8,
  9. T Luger9,
  10. P Mease10,
  11. I Olivieri11,
  12. J Reveille12,
  13. C Ritchlin13,
  14. M Rudwaleit14,
  15. J Sieper15,
  16. J S Smolen16,
  17. M de Wit17,
  18. D van der Heijde18
  1. 12nd Department of Internal Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
  2. 2Department of Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
  3. 3Department of Rheumatology, Hopital Cochin, Paris, France
  4. 4Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  5. 5Department of Rheumatology, St Vincents University Hospital, Dublin, Ireland
  6. 6University of California San Diego, La Jolla, California, USA
  7. 7Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  8. 8Department of Clinical immunology and Rheumatology, AMC Amsterdam, Amsterdam, The Netherlands
  9. 9Department of Dermatology, University of Münster, Münster, Germany
  10. 10University of Washington, Department of Rheumatology, Seattle, Washington, USA
  11. 11Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie, Potenza, Italy
  12. 12Department of Rheumatology, University Texas, Houston, Texas, USA
  13. 13Department of Rheumatology, University of Rochester Medical Center, Rochester, New York, USA
  14. 14Department of Medicine, Charité University Medicine, Berlin, Germany
  15. 15Medical Department I, Rheumatology, University Clinic Benjamin Franklin, Berlin, Germany
  16. 16Department of Rheumatology, Hietzing Hospital, Vienna, Austria
  17. 17Department of Medical Humanities, VU Medical Center, Amsterdam, The Netherlands
  18. 18Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Dr Monika M Schoels, 2nd Department of Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Wolkersbergenstrasse 1, Vienna 1130, Austria; monika.schoels{at}


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

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.

  • Spondyloarthritis
  • Psoriatic Arthritis
  • Ankylosing Spondylitis
  • Treatment

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