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Remission, Personalization Are Key in 2017 SpA, PsA Treatments to Target Update
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Researchers have published a 2017 update of treatments to target for patients with axial spondyloarthritis, peripheral spondyloarthritis and psoriatic arthritis.
“[An] update of recommendations to treat [spondyloarthritis] SpA to target is presented based on new evidence accrued over the past 5 years,” Josef S. Smolen, MD, from the Medical University of Vienna, and colleagues wrote.
Researchers made the following 11 recommendations:
- The treatment target should be clinical remission or inactive disease of musculoskeletal and extra-articular manifestations;
- The target should be personalized and based on current clinical manifestations of the disease, and the modality should be considered when determining the time required to reach the target;
- Clinical remission or inactive disease should be defined as the absence of clinical and laboratory evidence of significant disease activity;
- Low or minimal disease activity can be an alternative target;
- Disease activity should be measured by clinical signs and symptoms and acute phase reactants;
- Validated measures of musculoskeletal disease activity and assessment of cutaneous or other relevant extra-articular manifestations should be used in clinical practice to determine the target and guide treatment decisions and the frequency of the measurements should depend on disease activity level;
- Ankylosing spondylitis disease activity score is a preferred measure for axial SpA and the Disease activity in psoriatic arthritis score or minimal disease activity should be considered for psoriatic arthritis (PsA);
- The choice of target and the choice of disease activity measure should account for comorbidities, patient factors and drug-related risks;
- In addition to clinical and laboratory measures, imaging results can be used for clinical management;
- Once the treatment target is achieved, it should be maintained through the course of disease;
- Patients should be informed and involved in discussions about treatment target and the risks and benefits of the planned strategy.
“Adhering to these recommendations may significantly improve outcomes in patients with axial and peripheral SpA and PsA,” the researchers wrote. – by Will A. Offit
Disclosures: Smolen reports he received grant support from and/or provided expert advice to AbbVie, Amgen, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Celltrion, Gilead, GlaxoSmithKline, Iltoo, Janssen, Lilly, Pfizer, Roche, Samsung, Novartis-Sandoz and UCB.
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