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Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force

2013; BMJ; Volume: 73; Issue: 1 Linguagem: Inglês

10.1136/annrheumdis-2013-203419

1468-2060

Josef S Smolen, J. Braun, Maxime Dougados, Paul Emery, Oliver FitzGerald, Philip Helliwell, Arthur Kavanaugh, Tore K Kvien, Robert Landewé, Thomas A. Luger, Philip J. Mease, Ignazio Olivieri, John D. Reveille, Christopher T. Ritchlin, Martín Rudwaleit, Monika Schoels, Joachim Sieper, M. De Wit, Xenofon Baraliakos, Neil Betteridge, R Burgos-Vargas, Eduardo Collantes‐Estévez, Atul Deodhar, Dirk Elewaut, Laure Gossec, Merryn Jongkees, Mara Maccarone, Kurt Redlich, Filip Van den Bosch, James Cheng‐Chung Wei, Kevin Winthrop, Désirée van der Heijde,

Rheumatoid Arthritis Research and Therapies

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 patient9s 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.