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Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force
  1. Josef S Smolen1,2,
  2. Monika Schöls3,
  3. Jürgen Braun4,
  4. Maxime Dougados5,
  5. Oliver FitzGerald6,
  6. Dafna D Gladman7,
  7. Arthur Kavanaugh8,
  8. Robert Landewé9,
  9. Philip Mease10,
  10. Joachim Sieper11,
  11. Tanja Stamm12,
  12. Maarten de Wit13,
  13. Daniel Aletaha1,
  14. Xenofon Baraliakos4,
  15. Neil Betteridge14,
  16. Filip van den Bosch15,
  17. Laura C Coates16,
  18. Paul Emery17,
  19. Lianne S Gensler18,
  20. Laure Gossec19,
  21. Philip Helliwell20,
  22. Merryn Jongkees21,
  23. Tore K Kvien22,
  24. Robert D Inman23,
  25. Iain B McInnes24,
  26. Mara Maccarone25,
  27. Pedro M Machado26,
  28. Anna Molto5,
  29. Alexis Ogdie27,
  30. Denis Poddubnyy11,28,
  31. Christopher Ritchlin29,
  32. Martin Rudwaleit11,30,
  33. Adrian Tanew31,
  34. Bing Thio32,
  35. Douglas Veale33,
  36. Kurt de Vlam34,
  37. Désirée van der Heijde35
  1. 1 Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
  2. 2 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
  3. 3 Health Consult, Vienna, Austria
  4. 4 Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
  5. 5 Department of Rheumatology, Paris Descartes University, Paris, France
  6. 6 Department of Rheumatology, St Vincent’s University Hospital, Dublin, Ireland
  7. 7 Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
  8. 8 Division of Rheumatology, University of California, San Diego, CA, USA
  9. 9 Amsterdam Rheumatology & Immunology Center, Amsterdam, The Netherlands
  10. 10 Division of Rheumatology Research, Swedish-Providence St. Joseph Health System, University of Washington, Seattle, WA, USA
  11. 11 Department of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany
  12. 12 Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
  13. 13 Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands
  14. 14 Neil Betteridge Associates, UK
  15. 15 Ghent University Hospital, Ghent, Belgium
  16. 16 Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  17. 17 Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
  18. 18 Department of Medicine, University of California, San Francisco, CA, USA
  19. 19 Department of Rheumatology, UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS); AP-HP, Pitié Salpêtrière Hospital, Paris, France
  20. 20 Institute of Molecular Medicine, University of Leeds, Leeds, UK
  21. 21 Seayn Medical, Voorschoten, The Netherlands
  22. 22 Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  23. 23 University Health Network and University of Toronto, Toronto, Ontario, Canada
  24. 24 University of Glasgow, College of Medical Veterinary and Life Sciences, Glasgow, UK
  25. 25 A.DI.PSO. (Associazione per la Difesa degli Psoriasici)—PE.Pso.POF (Pan European Psoriasis Patients’ Organization Forum), Rome, Italy
  26. 26 Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK
  27. 27 Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA
  28. 28 German Rheumatism Research Centrer, Berlin, Germany
  29. 29 Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center Rochester, New York, NY, USA
  30. 30 Division of Internal Medicine and Rheumatology, Klinikum Bielefeld, Bielefeld, Germany
  31. 31 Department of Dermatology, Medical University of Vienna, Vienna, Austria
  32. 32 Department of Dermatology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
  33. 33 Department of Rheumatology, Klinikum Bielefeld, Bielefeld, Germany
  34. 34 Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
  35. 35 Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Josef S Smolen, Division of Rheumatology, Department of Medicine 3,Medical University of Vienna, Waehringer Guertel 19-20, 1090 Vienna, Austria; josef.smolen{at}


Therapeutic targets have been defined for axial and peripheral spondyloarthritis (SpA) in 2012, but the evidence for these recommendations was only of indirect nature. These recommendations were re-evaluated in light of new insights. Based on the results of a systematic literature review and expert opinion, a task force of rheumatologists, dermatologists, patients and a health professional developed an update of the 2012 recommendations. These underwent intensive discussions, on site voting and subsequent anonymous electronic voting on levels of agreement with each item. A set of 5 overarching principles and 11 recommendations were developed and voted on. Some items were present in the previous recommendations, while others were significantly changed or newly formulated. The 2017 task force arrived at a single set of recommendations for axial and peripheral SpA, including psoriatic arthritis (PsA). The most exhaustive discussions related to whether PsA should be assessed using unidimensional composite scores for its different domains or multidimensional scores that comprise multiple domains. This question was not resolved and constitutes an important research agenda. There was broad agreement, now better supported by data than in 2012, that remission/inactive disease and, alternatively, low/minimal disease activity are the principal targets for the treatment of PsA. As instruments to assess the patients on the path to the target, the Ankylosing Spondylitis Disease Activity Score (ASDAS) for axial SpA and the Disease Activity index for PSoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA) for PsA were recommended, although not supported by all. Shared decision-making between the clinician and the patient was seen as pivotal to the process. The task force defined the treatment target for SpA as remission or low disease activity and developed a large research agenda to further advance the field.

  • Spondyloarthritis
  • Ankylosing Spondylitis
  • Psoriatic Arthritis
  • Treatment
  • Outcomes Research

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  • Contributors All authors have contributed to the development of the recommendations and the manuscript.

  • Competing interests DA served as a consultant and/or speaker for Abbvie, Astra-Zeneca, BMS, Janssen, Medac, MSD, Pfizer, Roche, UCB and received grant support from BMS. XB has served as consultant and/or speaker for Abbvie, BMS, Celgene, Chugai, Janssen, Novartis, Pfizer, UCB. NB has received consultancy fees for work commissioned by Grünenthal, Lilly, Janssen, PfizerLaura Coates has received research funding from Abbvie and Janssen and honoraria from Abbvie, Amgen, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Sun Pharma, UCBMaxime Dougados has participated as a speaker in symposia or as an advisor in boards organized by Pfizer, Abbvie, Ucb, Merck, Amgen, Novartis, Lilly, Bms, Roche and his department has received research grants from Pfizer, Abbvie, Ucb, Merck, Amgen, Novartis, Lilly, Bms, Roche. Laure Gossec has received honoraria or research funding from Abbvie, BMS, Celgene, Janseen, MSD, Novartis, Pfizer, Roche and UCB. PE has undertaken clinical trials and provided expert advice to Pfizer, MSD, Abbvie, BMS, UCB, Roche, Novartis, Samsung, Sandoz and Lilly. OF reports grants and personal fees from Novartis, personal fees from Pfizer, personal fees from Lilly, personal fees from Cellgene, grants and personal fees from Abbvie, personal fees from Janssen, personal fees from UCB, outside the submitted work. AK has served as consultant and/or performed clinical research for Abbvie, Amgen, Celgene, Janssen, Novartis, UCB. PMM has received consultancy/speaker’s fees from AbbVie, Centocor, Janssen, Merck, Novartis, Pfizer and UCB. AM has received honoraria from Abbvie, MSD and UCBDP has received Grant/research support from: AbbVie, MSD, Novartis, Pfizer, has honoraria/speaker fees from AbbVie, BMS, Boehringer, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB. MR has received honoraria/ consultancies from Abbvie, BMS, Celgene, Chugai/Roche, Janssen, MSD, Novartis, Pfizer, UCB. JS has received grant support from and/or provided expert advice to Abbvie, Amgen, Astra-Zeneca, BMS, Boehringer-Ingelheim, Celgene, Celltrion, Gilead, Glaxo, Iltoo, Janssen, Lilly, Pfizer, MSD, Roche, Samsung, Novartis-Sandoz, UCB. TS has received honoraria from Abbvie, Janssen, MSD, Novartis and Roche and grant support from Abbvie. FVB has received speaker and/or consultancy fees from AbbVie, Celgene, Janssen,Lilly, MSD, Novartis, Pfizer and UCB. DH has received consulting fees Afrom bbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB, and is Director of Imaging Rheumatology bv. MW has received consulting fees for lectures or advisory board meetings from Abbvie, BMS, Celgene, Eli Lilly, Novartis and Roche.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it published Online First. The figure 2 legend has been corrected.

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