Targeting clinical remission is currently the focus of the treat-to-target strategy. Defining clinical outcomes as the main achievable treatment goal questions whether imaging remission should also be considered in the treat-to-target concept. Imaging has gained a pivotal role in diagnosing and classifying axial spondyloarthritis at the earliest phase of the disease. Its importance has been expanded to monitoring and prognosticating spondyloarthritis. This article summarizes current evidence on the use of imaging for monitoring disease activity and predicting treatment response in axial spondyloarthritis, and discusses the concept of imaging-driven treat-to-target strategy with a highlight on the newest imaging modalities in spondyloarthritis.
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