Updated treatment targets for axial and peripheral spondyloarthritis
medwireNews: An international taskforce has developed updated recommendations on therapeutic targets for spondyloarthritis (SpA) in light of evidence from the past 5 years.
The original recommendations developed in 2012 “were based on evidence levels of the lowest category […], which derives solely from expert opinion,” says the group, led by Josef Smolen (Medical University of Vienna, Austria).
A research agenda was then proposed with the aim of improving the definition of treatment targets, and subsequent publications “have addressed several points raised in the research agenda,” they explain.
In the 2017 update, the team of rheumatologists, dermatologists, patient representatives, and a nonmedical health professional proposed five main principles and 11 recommendations for axial and peripheral SpA, including psoriatic arthritis (PsA), based on the results of a systematic literature review and expert discussion. They also put forward an updated research agenda.
The five overarching principles, which are broadly in line with the 2012 recommendations but with some rewording based on the latest evidence, recommend that rheumatologists should:
- Set the treatment target based on shared decision-making between patient and physician
- Measure disease activity regularly and adjust therapy accordingly to improve outcomes
- Coordinate the management of musculoskeletal and extra-articular disease manifestations with other specialties
- Optimize long-term health-related quality of life and social participation by controlling signs and symptoms, preventing structural damage, preserving function, avoiding toxicities, and minimizing comorbidities
- Aim to abrogate inflammation to achieve these treatment goals
The 11 recommendations specify that the treatment target should be clinical remission/inactive disease of musculoskeletal and extra-articular manifestations, or alternatively low or minimal disease activity. And the target should be individualized based on current clinical manifestations, say the authors.
Patients do not leave their skin or their joints at the door when coming to see their specialist.
The recommendations also advocate the Ankylosing Spondylitis Disease Activity Score (ASDAS) as the preferred measure of disease activity for axial SpA, whereas the Disease Activity index for PSoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA) scores should be used for patients with PsA.
Smolen and colleagues recommend that when the treatment target has been achieved, it “should ideally be maintained throughout the course of the disease.”
And they conclude in the Annals of the Rheumatic Diseases.: “Adhering to these recommendations may significantly improve outcomes in patients with axial and peripheral SpA and PsA.”
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