Difficult-to-Treat Axial Spondyloarthritis: A New Challenge

Area of Science:

• Rheumatology
• Immunology
• Clinical Medicine

Background:

• Axial spondyloarthritis (AxSpA) is a prevalent chronic inflammatory rheumatic disease.
• Current treatments include non-pharmacological methods, NSAIDs, and advanced therapies like biologics.
• Treatment goals are remission or low disease activity, with adjustments if targets aren't met.

Purpose of the Study:

• To define difficult-to-treat (D2T) axial spondyloarthritis.
• To identify factors contributing to treatment resistance in AxSpA.
• To propose strategies for managing D2T patients.

Main Methods:

• Review of current treatment paradigms for AxSpA.
• Analysis of factors leading to treatment failure.
• Conceptual framework for defining D2T AxSpA.

Main Results:

• Multiple treatment changes indicate potential D2T disease.
• A consensual definition of D2T requires assessing inflammation, pain, degeneration, and psychosocial factors.
• D2T patients represent a distinct subgroup requiring tailored management.

Conclusions:

• Recognizing D2T axial spondyloarthritis is crucial for identifying at-risk patients.
• Management of D2T AxSpA involves analyzing treatment failures and considering holistic patient factors.
• Future strategies may include intensified non-pharmacological approaches and combination therapies.