Treat to target in axial spondyloarthritis: From its concept to its implementation

Treat to target is defined by a process defining a level of a relevant outcome of the disease to be reached in order to prevent subsequent disability The benefit of a Treat to Target strategy has been clearly demonstrated in chronic diseases such as diabetes and hypertension. A better knowledge of the natural history of chronic inflammatory rheumatic diseases including axial spondyloarthritis has emphasized the deleterious long term effect of a sustained inflammation, usually evaluated by disease activity markers. The Treat to Treat strategy in axial spondyloarthritis has emerged since the possibility of getting treatments not only capable to improve the current symptomatic situation of the patient but also to prevent further deleterious irreversible hard endpoints such as disability due to structural damage or important comorbidities such as renal failure or cardiovascular diseases. This is particularly the case for the "conventional" biologics (e.g. TNF blockers) with an experience in daily practice for at least two decades but also for more recent biologics (e.g. anti IL17 inhibitors) and for some promising targeted synthetic Disease Modifying AntiRheumatics Drugs (e.g. JAK kinase inhibitors) moreover, a part from the abrogation of inflammation, other targets can be considered such as smoking cessation, NSAID intake reduction or treatment of predisposing factors of cardiovascular diseases (e. g. hypertension, …). A Treat to Target strategy in axial spondyloarthritis has to consider the following different components:the stages of the disease, the risks of the disease, the reversible predisposing factors of the risks of the disease, the optimal threshold of the outcome measures evaluating the predisposing factors (TARGET), the time to reach the target and the necessity to maintain this success (sustainability). Moreover, the different methods/initiatives facilitating the implementation of a Treat to Target strategy in rheumatological daily practice have also to be considered (level of evidence, international recommendations, importance of the patient's participation, …).