10 April 2019

Too soon for T2T in SpA


Aggressive treat-to-target strategies in spondyloarthritis may be premature, according to the head of rheumatology at the Chinese University of Hong Kong.

Professor Lai-Shan Tam gave a presentation at the APLAR 2019 conference entitled “Treating Spondyloarthritis to Target: Are We Ready?”, a question that she left deliberately unanswered.

Treating to target involves the setting of specific goals, which are closely monitored while treatment is adjusted until they can be reached and maintained.

Professor Tam said that while remission was always the ultimate goal, validated targets that might be used included MDA (minimal disease activity), VLDA (very low disease activity) and DAPSA (disease activity in psoriatic arthritis).

The Ankylosing Spondylitis Disease Activity Score or ASDAS was also used, but had the disadvantage that it included C-reactive protein, which was not always elevated in all patients.

She cited recent papers suggesting benefits from aggressive therapy at the early stages of disease, to control inflammation and the resulting fat deposition and new bone formation.

But uncertainty remains as to which targets were best to pursue, and how hard to pursue whichever targets are chosen given a still relatively limited range of medication options.

Professor Tam said it was important that the assessments used to monitor long-term response reflected the overarching goals of treatment.

She concluded by saying that more data was needed as to whether T2T was appropriate for spondyloarthritis, as were a wider variety of treatment options.