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Treat-to-target in axial spondyloarthritis

gold standard or fools’ gold?

Machado, Pedro M.a,b,c; Deodhar, Atuld

Current Opinion in Rheumatology: July 2019 - Volume 31 - Issue 4 - p 344–348
doi: 10.1097/BOR.0000000000000625

Purpose of review Treat-to-target (T2T) is an emerging management strategy in axial spondyloarthritis (axSpA). The concept was originally based on evidence from other chronic conditions, such as hypertension, diabetes and hypothyroidism, as well as some rheumatic diseases, such as rheumatoid arthritis and gout. The purpose of this review is to discuss the arguments against and in favour of adopting a T2T strategy in the management of axSpA.

Recent findings International groups have recommended a T2T strategy in axSpA. Inactive disease according to the Ankylosing Spondylitis Disease Activity Score (ASDAS) has been suggested as a potential target. Achievement of ASDAS inactive disease has been associated with less progression of radiographic damage in several studies. Evidence for the benefit of a T2T approach has been published in psoriatic arthritis, a form of spondyloarthritis.

Summary Observational evidence suggests that a T2T approach might be beneficial in axSpA. However, data from a prospective randomized study proving the efficacy of a T2T strategy compared to routine care are still lacking. Moreover, the cost-effectiveness of such strategy in clinical practice also needs to be tested. The target will need to be useful and feasible in both clinical practice and clinical trials.

aDepartment of Rheumatology, University College London Hospitals NHS Foundation Trust

bDepartment of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust

cCentre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK

dOregon Health and Science University, Portland, Oregon, USA

Correspondence to Pedro M. Machado, MD, PhD, Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, 1st Floor, Russell Square House, 10-12 Russell Square, WC1B 5EH London, UK. E-mail:

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