Optimising PsA and axSpA Treatment: EULAR 2026 Focuses on Early Intervention

Psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) are chronic inflammatory conditions that can lead to irreversible structural damage and significant functional impairment if not managed effectively. The clinical dilemma lies in the variability of disease presentation and the often-delayed initiation of effective therapies, which can result in poorer long-term outcomes. Evidence consistently demonstrates that a 'treat-to-target' approach, coupled with early intervention, is critical for achieving disease control and preventing radiographic progression.¹ However, the practical implementation of these strategies in routine clinical settings can be inconsistent.²

Translating Evidence into Practice: EULAR 2026 Focus

The EULAR 2026 session, 'Translating Evidence into Practice: Achieving Treatment Success in PsA and axSpA Clinics,' will address key aspects of optimising patient management. A central theme will be the importance of early diagnosis. For PsA, the average delay from symptom onset to diagnosis can be 7 years, while for axSpA, it can extend to 5-10 years.^3,4 This diagnostic delay is a significant barrier to effective treatment, as early inflammatory changes can lead to permanent joint damage within the first few years of disease onset.⁵

The session will review the current understanding of disease pathogenesis and the rationale for early therapeutic intervention. Data from observational cohorts and randomised controlled trials consistently show that initiating disease-modifying antirheumatic drugs (DMARDs), particularly biologics or targeted synthetic DMARDs (tsDMARDs) such as JAK inhibitors, earlier in the disease course leads to superior outcomes. For instance, in early PsA, patients treated with biologics within 6 months of diagnosis demonstrated significantly lower rates of radiographic progression compared to those with delayed initiation.⁶ Similarly, in axSpA, early treatment with TNF inhibitors has been associated with better spinal mobility and reduced radiographic progression over 2 years, with a hazard ratio (HR) for progression of 0.65 (95% CI 0.48-0.88, p=0.005) compared to conventional therapy.⁷

A key focus will be on the 'treat-to-target' strategy, which involves setting specific, measurable treatment goals, such as minimal disease activity (MDA) in PsA or Ankylosing Spondylitis Disease Activity Score (ASDAS) remission in axSpA, and adjusting therapy until these targets are met.⁸ This approach has been shown to improve clinical outcomes, including functional status and quality of life, more effectively than standard care. For example, a study in PsA demonstrated that a treat-to-target strategy achieved MDA in 59% of patients at 12 months, compared to 35% in the standard care group (p<0.001).⁹

The session will also explore the role of multidisciplinary care and patient education in achieving treatment success. Effective management of PsA and axSpA requires collaboration between rheumatologists, dermatologists, physiotherapists, and other healthcare professionals. Patient engagement in treatment decisions and adherence to therapy are critical, with studies indicating that poor adherence can lead to suboptimal disease control in up to 50% of patients.¹⁰

Limitations in current practice often include a reliance on a step-wise approach to therapy, where conventional synthetic DMARDs (csDMARDs) are used for extended periods before escalating to advanced therapies, even in patients with high disease activity or poor prognostic factors. This can delay access to more effective treatments. The EULAR 2026 discussion will advocate for a more individualised approach, considering patient-specific factors and disease severity to guide early therapeutic choices. While no specific new trials will be presented, the session will synthesise existing evidence to provide practical guidance for clinicians, aiming to bridge the gap between research findings and routine clinical application.