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.