LAUSR

OBJECTIVE 'Treat-to-target principles' are advised for axial spondyloarthritis although a clear target is not yet defined and targets do not always reflect inflammation. Treat-to-target use and motives for treatment choices in clinics are unknown. Therefore, we studied presence of residual disease activity according physician's opinion, patient's opinion and composite indices, and compared them to the subsequent treatment decisions. METHODS This cross-sectional multicentre study included 249 patients with a clinical diagnosis of axial spondyloarthritis ≥ 6 months. Remission and low disease activity according to BASDAI (BASDAI < 1.9 and < 3.5 respectively), and to physician's and patient's opinion were assessed. Questionnaires included patient reported outcomes, and patients and physicians completed questions regarding treatment decisions. RESULTS 115/249 (46%) patients were in remission according to the physician and 37% (n = 43) of these patients reached remission according to BASDAI. In 51/83 (60%) of the patients with residual disease activity according to the physician and a BASDAI > 3.5 the treatment was left unchanged, either because of low disease activity as rated by the physician (n = 15, 29%), or because of a combination of low disease activity with non-inflammatory complaints or comorbidities (n = 11, 25%). Retrospective treat-to-target evaluation showed that treatments were most frequently intensified in patients with arthritis or inflammatory back pain and less often in patients with other (non-inflammatory) musculoskeletal comorbidities. CONCLUSION This study shows that physicians do not always strictly apply treat-to-target in case of residual disease activity in axial spondyloarthritis. Usually, they accept low disease activity as satisfactory.