Adherence to Biologics and Psycho-cognitive Factors in Axial Spondyloarthritis: A Multicentric Cross-sectional Study

Adherence to treatment in axial spondyloarthritis (axSpA) remains poorly documented, with estimates ranging from 28.2% to 70.6%. Psychological factors may influence adherence. This study aimed to assess adherence to biological disease-modifying antirheumatic drugs (bDMARDs) and evaluate the impact of catastrophizing, fibromyalgia, anxiety, and depression on adherence.

We conducted a 1-year multicenter cross-sectional study, including consecutive axSpA patients fulfilling ASAS criteria. Participants completed a self-administered questionnaire covering demographic data, disease characteristics, and activity scores. Adherence was assessed using the Girerd scale (GS); psychological assessments included the Pain Catastrophizing Scale (PCS), Fibromyalgia Rapid Screening Tool (FIRST), and Hospital Anxiety and Depression Scale (HADS).

Among 500 patients, 49.2% showed good adherence (GS=0). Prevalence of catastrophizing, fibromyalgia, anxiety, and depression was 17.2%, 21.4%, 25.6%, and 11.0%, respectively. Good adherence was significantly associated with older age (mean 53.3 vs. 45.9 y; p<0.001), retirement status (26.4% vs. 12.6%; p<0.001), and lower educational level (OR: 1.84; 95% CI: 1.23-2.75; p=0.003). Poor adherence was linked to anxiety (OR: 1.53; 95% CI: 1.02-2.30; p=0.041) and catastrophizing (OR: 1.61; 95% CI: 1.00-2.58; P=0.049). In multivariate analysis, younger age (OR: 0.96; 95% CI: 0.95-0.98; p<0.001) and anxiety (OR 1.72; 95% CI: 1.05-2.81; p=0.031) remained significantly associated with poor adherence.

About half of axSpA patients had suboptimal adherence to bDMARDs. Younger age, anxiety, and catastrophizing were associated with poor adherence and should be considered in patient management.