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A Migliore,1 G Gigliucci,1 RJ Petrella,2 RR Bannuru,3 X Chevalier,4 E Maheu,5 R Raman,6 G Herrero-Beaumont,7 N Isailovic,8 M Matucci Cerinc9 1Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy; 2Department of Family Medicine, School of Kinesiology Western University, Western Centre for Public Health & Family, London, Ontario, Canada; 3Center for Treatment Comparison and Integrative Analysis Division of Rheumatology, Tufts Medical Center, Boston, MA, USA; 4Department of Rheumatology, Hôpital Henri Mondor, Creteil, France; 5Rheumatology Department, AP-HP, Saint-Antoine Hospital, Paris, France; 6Academic Department of Orthopaedics, Hull and East Yorkshire NHS Trust, Castle Hill Hospital, Cottingham, UK; 7Joint and Bone Research Unit, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain; 8Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Milan, Italy; 9Division of Rheumatology AOUC, Department of Experimental and Clinical Medicine, University of Florence, Florence, ItalyCorrespondence: N IsailovicDivision of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano 20089, Milan, ItalyTel +39-02-8224-5118Email natasa.isailovic@humanitasresearch.itAbstract: Osteoarthritis (OA) is a rheumatic disease that affects the well-being of the patient, compromises physical and mental function, and affects other quality of life aspects. In the literature, several evidence-based guidelines and recommendations for the management of knee osteoarthritis (KOA) are available. These recommendations list the different therapeutic options rather than addressing a hierarchy between the treatments and defining the real target. Therefore, a question arises: are patients and physicians satisfied with the current management of KOA? Actually, the answer may be negative, thus suggesting a change in our therapeutic strategies. In this article, we address this challenge by suggesting that it is time to develop a “treat to target strategy” for KOA.Keywords: osteoarthritis, knee osteoarthritis, treat to target

Background: In this work, we aimed to establish a clinical target in the management of knee osteoarthritis (KOA) and to propose good clinical practice (GCP) statements for carrying out a treat-to-target strategy., Methods: A steering committee of seven experts had formulated a provisional set of recommendations that were exposed for discussion and modification to a technical expert panel (TEP) of 25 multidisciplinary experts from Europe, North America, South America and Asia. The level of evidence and strength of each recommendation was discussed. The TEP formulated overarching principles and GCP statements based on the level of agreement for each item with a vote using a 10-point numerical scale., Results: Two overarching principles and 10 GCP statements were formulated by the TEP. These GCP statements suggest: treatment should achieve clinical improvement bringing the patient to the Patient Acceptable Symptom State (PASS); pharmacological and nonpharmacological treatment should begin as early as possible, with an early diagnosis of symptomatic KOA; the patient should be evaluated every 3-6 months; risk factors of KOA progression should be identified and managed with patients at the beginning of the treatment and monitored regularly; treatment should be adapted according to patient phenotype and disease severity; healthy lifestyle must be promoted and monitored. The level of agreement average ranged from 8.7 to 9.6 on scale., Conclusions: The proposed overarching principles and GCP statements have the aim of involving patients, general practitioners and multidisciplinary specialists in sharing a therapeutic treat-to-target strategy for KOA management based on the best evidence and expert opinions., Competing Interests: Conflict of interest statement: Abiogen Pharma Spa supported all the costs of the meeting of the authors, including travel and subsistence. No honoraria were paid to the participants. Abiogen Pharma Spa had no input in the writing or editing of the paper., (© The Author(s), 2019.)