Treat to Target in Axial Spondyloarthritis: What Are the Issues?

PURPOSE OF THE REVIEW: Treat to Target (T2T) strategy has been widely used in the management of chronic medical conditions, such as hypertension, diabetes, and hypothyroidism, as well as rheumatic diseases, such as rheumatoid arthritis and gout. The purpose of this review is to discuss the importance, feasibility, and challenges in adopting the T2T strategy for the management of axial spondyloarthritis (axSpA).

RECENT FINDINGS: In 2014, a panel of international experts published recommendations for T2T in axSpA. Recent Tight Control of Inflammation in Early Psoriatic Arthritis (TICOPA) trial demonstrated efficacy of T2T in the management of the psoriatic arthritis. However, there are several issues in the adoption of T2T in axSpA. They include lack of evidence of the impact of aggressive management on clinical and radiographic outcomes in axSpA and unavailability of a definite target for the treatment, as well as limited therapeutic options. In this review, we discuss the intricacies of the T2T strategy in axSpA. We need more clinical evidence in the form of randomized clinical studies to assess the impact of T2T on outcomes in axSpA. We also need a definite target which is useful in the routine clinical practice, as well as for clinical trials.