Table 3

The 2017 updated treat-to-target recommendations for spondyloarthritis

LoEGoRVotingLoA (0–10)
Mean (SD)
Overarching principles
A.The treatment target must be based on a shared decision between patient and rheumatologistn.a.n.a.69.4%9.7 (0.7)
B.Treatment to target by measuring disease activity, and adjusting therapy accordingly, improves outcomesn.a.n.a.83.3%9.3 (1.2)
C.SpA and PsA are multifaceted systemic diseases; the management of musculoskeletal and extra-articular manifestations should be coordinated, as needed, between the rheumatologist and other specialists (such as dermatologist, gastroenterologist, ophthalmologist)n.a.n.a.86.1%9.8 (0.5)
D.The goals of treating the patient with SpA or PsA are to optimise long-term health-related quality of life and social participation through control of signs and symptoms, prevention of structural damage, normalisation or preservation of function, avoidance of toxicities and minimisation of comorbiditiesn.a.n.a.86.1%9.9 (0.3)
E.Abrogation of inflammation is important to achieve these goalsn.a.n.a.94.4%9.2 (1.8)
1.The treatment target should be clinical remission/inactive disease of musculoskeletal (arthritis, dactylitis, enthesitis, axial disease) and extra-articular manifestations5D75%9.2 (1.8)
2.The treatment target should be individualised based on the current clinical manifestations of the disease; the treatment modality should be considered when defining the time required to reach the target5D94.4%9.6 (0.8)
3.Clinical remission/inactive disease is defined as the absence of clinical and laboratory evidence of significant disease activity2cB88.9%9.6 (0.6)
4.Low/minimal disease activity may be an alternative treatment target2b/5*B/D*97.2%9.6 (0.9)
5.Disease activity should be measured on the basis of clinical signs and symptoms, and acute phase reactants2cB88.9%9.3 (0.9)
6.Validated measures of musculoskeletal disease activity and assessment of cutaneous and/or other relevant extra-articular manifestations, should be used in clinical practice to define the target and to guide treatment decisions; the frequency of the measurements depends on the level of disease activity5D84.4%9.4 (0.8)
7.In axial SpA, ASDAS is a preferred measure and in PsA DAPSA or MDA should be considered to define the target2cB51.6%7.9 (2.5)
8.The choice of the target and of the disease activity measure should take comorbidities, patient factors and drug-related risks into account5D91.4%9.5 (1.7)
9.In addition to clinical and laboratory measures, imaging results may be considered in clinical management5D93.9%9.1 (1.3)
10.Once the target is achieved, it should ideally be maintained throughout the course of the disease2cB100%9.8 (0.5)
11.The patient should be appropriately informed and involved in the discussions about the treatment target, and the risks and benefits of the strategy planned to reach this target5D76.5%9.9 (0.4)
  • *2b (A) for PsA, 5 (D) for axial SpA.

  • ASDAS, Ankylosing Spondylitis Disease Activity Score; DAPSA, Disease Activity index for PSoriatic Arthritis; LoA, level of agreement among the task force members (mean (SD); LoE, level of evidence and GoR, grade of recommendation, both according to the Oxford Centre of Evidence-Based Medicine (evidence as provided by clinical trials underlying the recommendation); MDA, Minimal Disease Activity; n.a., not applicable; PsA, psoriatic arthritis; SpA, spondyloarthritis.