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<p>Patients with axial spondyloarthritis (AxSpA) with difficult-to-manage (D2M) or treatment-refractory (TR) disease represent an unmet clinical need, but real-world data remain limited. To determine the frequency, demographic, clinical, and psychosocial characteristics of D2M and TR AxSpA patients in a real-world setting, we analyzed data from the Greek AxSpA Registry. D2M disease was defined as Ankylosing Spondylitis Disease Activity Score [ASDAS] ≥ 2.1 despite failure of ≥ 2 biologic (b) or targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) with different mechanisms of action. TR was defined as D2M status plus C-reactive protein (CRP) ≥ 0.5&#xa0;mg/dL after exclusion of infectious causes. D2M, TR, and non-D2M groups were compared and factors associated with D2M status were explored using multivariable regression analysis. Among 395 patients with AxSpA, 40 (10.1%) patients were classified as D2M and 22 (5.6%) as TR. In univariable analysis, higher BASDAI at diagnosis, extra-spinal manifestations (arthritis, dactylitis, enthesitis and psoriasis), BMI ≥ 25&#xa0;kg/m², current smoking, depression, number of comorbidities, as well as unemployment were associated with the D2M status. In multivariable analysis, unemployment (OR 6.08, 95% CI 1.90–19.46), BASDAI at diagnosis (OR 1.62, 95% CI 1.17–2.24), and depression (OR 2.97, 95% CI 1.04–8.50) remained independently associated with D2M status. Patients with TR AxSpA were characterized by higher BASDAI at diagnosis, more syndesmophytes, and multiple comorbidities. D2M AxSpA is characterized by a more aggressive disease from the outset and throughout, a higher frequency of comorbidities, particularly depression, and an independent association with unemployment. These findings support multidisciplinary management targeting inflammatory burden, modifiable lifestyle factors and psychosocial vulnerability.</p>

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Disease-related and psychosocial factors associated with difficult-to-manage and treatment-refractory axial spondyloarthritis: insights from the Greek AxSpA Registry

  • 期刊论文

  • 发表日期：

    2026年7月8日

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  • N. Kougkas,
  • Konstantinos Tsafis,
  • Dimitrios Deligeorgakis,
  • Vassileios Papadopoulos,
  • Nikolaos Fytanidis,
  • Michael Krikelis,
  • Evangelia N. Mole,
  • Sousana Gazi,
  • Nikolaos Koletsos,
  • Evripidis Kaltsonoudis,
  • P. V. Voulgari,
  • Anastasios Karamanakos,
  • Maria Pappa,
  • Maria G. Tektonidou,
  • P. P. Sfikakis,
  • Kalliopi Klavdianou,
  • Aggelos Banos,
  • Elena Kalavri,
  • Konstantinos Kottas,
  • Gkikas Katsifis,
  • Maria Konsta,
  • Eleftheria Grika,
  • Charalampos Sfontouris,
  • Evgenia Mavrea,
  • Christos Koutsianas,
  • Evangelia Kataxaki,
  • Elena Sampatakaki,
  • Konstantina Zoupidou,
  • Pelagia Katsimbri,
  • Alexios Iliopoulos,
  • Georgios Iliopoulos,
  • Dimitrios Daoussis,
  • Ilias Bournazos,
  • Dimos Patrikos,
  • Theodoros Dimitroulas,
  • Dimitrios Vassilopoulos,
  • G. E. Fragoulis,
  • Charalampos Papagoras

摘要

Patients with axial spondyloarthritis (AxSpA) with difficult-to-manage (D2M) or treatment-refractory (TR) disease represent an unmet clinical need, but real-world data remain limited. To determine the frequency, demographic, clinical, and psychosocial characteristics of D2M and TR AxSpA patients in a real-world setting, we analyzed data from the Greek AxSpA Registry. D2M disease was defined as Ankylosing Spondylitis Disease Activity Score [ASDAS] ≥ 2.1 despite failure of ≥ 2 biologic (b) or targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) with different mechanisms of action. TR was defined as D2M status plus C-reactive protein (CRP) ≥ 0.5 mg/dL after exclusion of infectious causes. D2M, TR, and non-D2M groups were compared and factors associated with D2M status were explored using multivariable regression analysis. Among 395 patients with AxSpA, 40 (10.1%) patients were classified as D2M and 22 (5.6%) as TR. In univariable analysis, higher BASDAI at diagnosis, extra-spinal manifestations (arthritis, dactylitis, enthesitis and psoriasis), BMI ≥ 25 kg/m², current smoking, depression, number of comorbidities, as well as unemployment were associated with the D2M status. In multivariable analysis, unemployment (OR 6.08, 95% CI 1.90–19.46), BASDAI at diagnosis (OR 1.62, 95% CI 1.17–2.24), and depression (OR 2.97, 95% CI 1.04–8.50) remained independently associated with D2M status. Patients with TR AxSpA were characterized by higher BASDAI at diagnosis, more syndesmophytes, and multiple comorbidities. D2M AxSpA is characterized by a more aggressive disease from the outset and throughout, a higher frequency of comorbidities, particularly depression, and an independent association with unemployment. These findings support multidisciplinary management targeting inflammatory burden, modifiable lifestyle factors and psychosocial vulnerability.