RT Journal Article SR Electronic T1 Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force JF Annals of the Rheumatic Diseases JO Ann Rheum Dis FD BMJ Publishing Group Ltd and European League Against Rheumatism SP 6 OP 16 DO 10.1136/annrheumdis-2013-203419 VO 73 IS 1 A1 Smolen, Josef S A1 Braun, Jürgen A1 Dougados, Maxime A1 Emery, Paul A1 FitzGerald, Oliver A1 Helliwell, Philip A1 Kavanaugh, Arthur A1 Kvien, Tore K A1 Landewé, Robert A1 Luger, Thomas A1 Mease, Philip A1 Olivieri, Ignazio A1 Reveille, John A1 Ritchlin, Christopher A1 Rudwaleit, Martin A1 Schoels, Monika A1 Sieper, Joachim A1 Wit, Martinus de A1 Baraliakos, Xenofon A1 Betteridge, Neil A1 Burgos-Vargas, Ruben A1 Collantes-Estevez, Eduardo A1 Deodhar, Atul A1 Elewaut, Dirk A1 Gossec, Laure A1 Jongkees, Merryn A1 Maccarone, Mara A1 Redlich, Kurt A1 van den Bosch, Filip A1 Wei, James Cheng-Chung A1 Winthrop, Kevin A1 van der Heijde, Désirée YR 2014 UL http://ard.bmj.com/content/73/1/6.abstract AB Background Therapeutic targets have been defined for diseases like diabetes, hypertension or rheumatoid arthritis and adhering to them has improved outcomes. Such targets are just emerging for spondyloarthritis (SpA). Objective To define the treatment target for SpA including ankylosing spondylitis and psoriatic arthritis (PsA) and develop recommendations for achieving the target, including a treat-to-target management strategy. Methods Based on results of a systematic literature review and expert opinion, a task force of expert physicians and patients developed recommendations which were broadly discussed and voted upon in a Delphi-like process. Level of evidence, grade and strength of the recommendations were derived by respective means. The commonalities between axial SpA, peripheral SpA and PsA were discussed in detail. Results Although the literature review did not reveal trials comparing a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated the development of recommendations. The group agreed on 5 overarching principles and 11 recommendations; 9 of these recommendations related commonly to the whole spectrum of SpA and PsA, and only 2 were designed separately for axial SpA, peripheral SpA and PsA. The main treatment target, which should be based on a shared decision with the patient, was defined as remission, with the alternative target of low disease activity. Follow-up examinations at regular intervals that depend on the patient's status should safeguard the evolution of disease activity towards the targeted goal. Additional recommendations relate to extra-articular and extramusculoskeletal aspects and other important factors, such as comorbidity. While the level of evidence was generally quite low, the mean strength of recommendation was 9–10 (10: maximum agreement) for all recommendations. A research agenda was formulated. Conclusions The task force defined the treatment target as remission or, alternatively, low disease activity, being aware that the evidence base is not strong and needs to be expanded by future research. These recommendations can inform the various stakeholders about expert opinion that aims for reaching optimal outcomes of SpA.