From clinical remission to residual disease activity in spondyloarthritis and its potential treatment implications

INTRODUCTION: Remission or low disease activity should be the target of therapy in spondyloarthritis (SpA). Due to the complexity of the disease, several composite indices that assess all disease domains were proposed to define a status of low disease activity/remission in both axial and peripheral SpA. With the introduction, in the past years, of effective biologic and targeted synthetic treatments aimed at inhibiting key cytokines and intracellular pathways, the goal of clinical remission has become an achievable target in these conditions. However, residual disease activity may occur in some domains and the management of patients that achieve the target of remission is still an unmet need. Areas covered: This manuscript aimed to review the current evidence on clinical remission and residual disease activity in SpA (both axial SpA and psoriatic arthritis), and its potential treatment implications. Expert commentary: Progress in our understanding of the pathogenesis of SpA will lead to a rapid increase in the number of available treatments, with the possibility for patients to achieve a status of remission. However, the topic of residual disease activity should be taken into consideration.