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

Josef S. Smolen, Jürgen Braun, Maxime Dougados, Paul Emery, Oliver FitzGerald, Philip Helliwell, Arthur Kavanaugh, Tore K. Kvien, Robert Landewé, Thomas Luger, Philip Mease, Ignazio Olivieri, John Reveille, Christopher Ritchlin, Martin Rudwaleit, Monika Schoels, Joachim Sieper, Martinus De Wit, Xenofon Baraliakos, Neil BetteridgeRuben Burgos-Vargas, Eduardo Collantes-Estevez, Atulya (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

Research output: Contribution to journalArticle

275 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)6-16
Number of pages11
JournalAnnals of the Rheumatic Diseases
Volume73
Issue number1
DOIs
StatePublished - Jan 2014

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Psoriatic Arthritis
Ankylosing Spondylitis
Advisory Committees
Expert Testimony
Therapeutics
Medical problems
Comorbidity
Rheumatoid Arthritis
Joints
Hypertension
Physicians
Research

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Allergy

Cite this

Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target : Recommendations of an international task force. / Smolen, Josef S.; Braun, Jürgen; Dougados, Maxime; Emery, Paul; FitzGerald, Oliver; Helliwell, Philip; Kavanaugh, Arthur; Kvien, Tore K.; Landewé, Robert; Luger, Thomas; Mease, Philip; Olivieri, Ignazio; Reveille, John; Ritchlin, Christopher; Rudwaleit, Martin; Schoels, Monika; Sieper, Joachim; De Wit, Martinus; Baraliakos, Xenofon; Betteridge, Neil; Burgos-Vargas, Ruben; Collantes-Estevez, Eduardo; Deodhar, Atulya (Atul); Elewaut, Dirk; Gossec, Laure; Jongkees, Merryn; Maccarone, Mara; Redlich, Kurt; Van Den Bosch, Filip; Cheng-Chung Wei, James; Winthrop, Kevin; Van Der Heijde, Désirée.

In: Annals of the Rheumatic Diseases, Vol. 73, No. 1, 01.2014, p. 6-16.

Research output: Contribution to journalArticle

Smolen, JS, Braun, J, Dougados, M, Emery, P, FitzGerald, O, Helliwell, P, Kavanaugh, A, Kvien, TK, Landewé, R, Luger, T, Mease, P, Olivieri, I, Reveille, J, Ritchlin, C, Rudwaleit, M, Schoels, M, Sieper, J, De Wit, M, Baraliakos, X, Betteridge, N, Burgos-Vargas, R, Collantes-Estevez, E, Deodhar, AA, Elewaut, D, Gossec, L, Jongkees, M, Maccarone, M, Redlich, K, Van Den Bosch, F, Cheng-Chung Wei, J, Winthrop, K & Van Der Heijde, D 2014, 'Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: Recommendations of an international task force', Annals of the Rheumatic Diseases, vol. 73, no. 1, pp. 6-16. https://doi.org/10.1136/annrheumdis-2013-203419
Smolen, Josef S. ; Braun, Jürgen ; Dougados, Maxime ; Emery, Paul ; FitzGerald, Oliver ; Helliwell, Philip ; Kavanaugh, Arthur ; Kvien, Tore K. ; Landewé, Robert ; Luger, Thomas ; Mease, Philip ; Olivieri, Ignazio ; Reveille, John ; Ritchlin, Christopher ; Rudwaleit, Martin ; Schoels, Monika ; Sieper, Joachim ; De Wit, Martinus ; Baraliakos, Xenofon ; Betteridge, Neil ; Burgos-Vargas, Ruben ; Collantes-Estevez, Eduardo ; Deodhar, Atulya (Atul) ; Elewaut, Dirk ; Gossec, Laure ; Jongkees, Merryn ; Maccarone, Mara ; Redlich, Kurt ; Van Den Bosch, Filip ; Cheng-Chung Wei, James ; Winthrop, Kevin ; Van Der Heijde, Désirée. / Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target : Recommendations of an international task force. In: Annals of the Rheumatic Diseases. 2014 ; Vol. 73, No. 1. pp. 6-16.
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abstract = "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.",
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T1 - Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target

T2 - Recommendations of an international task force

AU - Smolen, Josef S.

AU - Braun, Jürgen

AU - Dougados, Maxime

AU - Emery, Paul

AU - FitzGerald, Oliver

AU - Helliwell, Philip

AU - Kavanaugh, Arthur

AU - Kvien, Tore K.

AU - Landewé, Robert

AU - Luger, Thomas

AU - Mease, Philip

AU - Olivieri, Ignazio

AU - Reveille, John

AU - Ritchlin, Christopher

AU - Rudwaleit, Martin

AU - Schoels, Monika

AU - Sieper, Joachim

AU - De Wit, Martinus

AU - Baraliakos, Xenofon

AU - Betteridge, Neil

AU - Burgos-Vargas, Ruben

AU - Collantes-Estevez, Eduardo

AU - Deodhar, Atulya (Atul)

AU - Elewaut, Dirk

AU - Gossec, Laure

AU - Jongkees, Merryn

AU - Maccarone, Mara

AU - Redlich, Kurt

AU - Van Den Bosch, Filip

AU - Cheng-Chung Wei, James

AU - Winthrop, Kevin

AU - Van Der Heijde, Désirée

PY - 2014/1

Y1 - 2014/1

N2 - 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.

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.

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