New Guidelines Support Treat-to-Target for SpA

New guidelines recently published in the Annals of the Rheumatic Diseases outlined principles geared toward a spondyloarthritis management strategy of targeting remission or disease inactivity and adjusting treatment as necessary to achieve that targeted goal.

“An update of recommendations to treat SpA to target is presented based on new evidence accrued over the past 5 years,” the panelists wrote. “Adhering to these recommendations may significantly improve outcomes in patients with axial and peripheral SpA and PsA.”

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The recommendations were developed by a panel of 36 rheumatologists from Europe and North America experienced in SpA clinical research.  The new guidelines were developed to update 2012 treat-to-target recommendations that included vague wording and minial evidence-based recommendations. Together, the panelists developed 5 main principles for a treat-to-target management strategy for patients with axial and peripheral SpA.  The principles included:

• setting mutually agreed upon treatment targets developed with patients;
• adjusting treatments based on monitored outcomes and progress, measured through disease activity scales;
• coordinating with other specialists to treat musculoskeletal and extra-articular issues;
• optimizing long-term quality of life through prevention of disease progression; and,
• working to stave off inflammation.

A number of the 11 recommendations made by the panelists included a patient-centered focus. They advised rheumatologists to take patient preference into account for treatment selection and to keep the patient informed and involved in the therapies’ progress. The recommendations also noted that treatment levels should be maintained once a target is achieved, through the entire course of the disease.

“These recommendations are deliberately generic and intended to inform the optimal treatment approach rather than advise around a specific drug entity, since it was deemed important to develop and describe a conceptual framework independent of particular drug availability or preference,” the panelists wrote.

—David Costill