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Clinical and Radiographic Factors Associated With Difficult-to-Manage Axial Spondyloarthritis: A Multicenter Study
Haluk Cinakli1, Mete Kara2, Gülay Alp3
1Rheumatology Department, Kırklareli Training and Research Hospital, Kırklareli, Turkey.
International Journal of Rheumatic Diseases
|January 28, 2026
Summary
The study identified difficult-to-manage axial spondyloarthritis (axSpA) in 11.2% of patients, characterized by higher disease activity and specific comorbidities. Optimized treatment strategies are crucial for these patients.
Area of Science:
- Rheumatology
- Immunology
- Clinical Medicine
Background:
- Axial spondyloarthritis (axSpA) poses a significant disease burden.
- The Assessment of Spondyloarthritis International Society (ASAS) recently defined difficult-to-manage axSpA (D2M-axSpA).
- Understanding the characteristics of D2M-axSpA is crucial for effective management.
Purpose of the Study:
- To evaluate the clinical characteristics, disease burden, and treatment patterns of axSpA using the ASAS definition of D2M-axSpA.
- To identify factors associated with D2M-axSpA.
Main Methods:
- A multicenter cross-sectional study enrolled 383 axSpA patients.
- Patients were classified as D2M-axSpA based on prior b/tsDMARD use and persistent disease activity.
- Logistic regression analysis identified factors associated with D2M-axSpA.
Main Results:
- 11.2% of patients met the D2M-axSpA criteria.
- D2M-axSpA patients showed higher inflammatory markers, disease activity, and functional impairment.
- Anterior uveitis, peripheral arthritis, comorbidities, and smoking history were associated with D2M-axSpA.
Conclusions:
- D2M-axSpA presents a substantial clinical and radiographic burden.
- Optimized treatment strategies are needed for D2M-axSpA patients.
- Particular attention should be given to patients with comorbidities, anterior uveitis, peripheral arthritis, or a smoking history.
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