[Associated factors of difficult-to-treat spondyloarthritis]

Biotherapies have revolutionised the management of spondyloarthritis (SpA). Despite these advances, there is still a proportion of patients with multiple changes in biological markers, which may correspond to difficult-to-treat spondyloarthritis (SPA D2T). Our study aims to explore the prevalence of this particular entity and to characterise its clinical aspects in a Moroccan population.

This is a comparative cross-sectional study that included patients with SpA admitted to the department on biologic therapies. Sociodemographic, comorbidity, clinical, paraclinical and therapeutic data were collected. Patients who had received at least two biologics were considered to be SpA D2T. A comparison was made with a control group of non-multi-switchers (SpA-non-D2T).

210 patients were included, 56.2% of whom were men. The prevalence of multi-switchers was 32,7%. D2T SpA patients were predominantly female (53,6% versus 39%, p= 0,04), had more axial involvement (76,8% versus 91,5%, p= 0,003), CsDMARD use (97,1% versus 31,9%, p= 0,001). Disease activity at the initiation of biotherapy was higher in D2T-ASDs. The time between diagnosis and use of the first biologic was longer (4 [2,25-6] years versus 3 [1-4] years, p = 0,03). All D2T-SPA patients had received anti-TNFα.

Our study found a high prevalence of D2T-SpA.