Difficult to Manage Axial Spondyloarthritis Save

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, causing back pain, stiffness, and reduced mobility. The disease includes both non-radiographic axSpA and ankylosing spondylitis (AS), distinguished by the presence or absence of visible damage on imaging like X-rays.

Studies show that patients with difficult-to-manage (D2M) axSpA have a higher disease activity; however, the lack of a consensus definition led researchers and clinicians to utilize their own proposed definition resulting in variability of the characteristics of non-responders.

Abstract 0819 from The Assessment of Spondyloarthritis International Society (ASAS) presents a consensus-based definition of D2M axSpA for use in clinical and research settings. To classify a patient as D2M axSpA (diagnosed by a rheumatologist), 3 criteria must be met: treatment failure of > 2 b/tsDMARDs with different mechanisms of action; objective evidence of high disease activity or radiographic progression; and, the presence of signs/symptoms perceived as problematic by the patient and/or physician.

Early identification of risk factors for D2M axSpA is crucial for developing an effective and personalized care plan.

Abstract 0573 outlined the baseline characteristics of D2M AS using real world data from 96,037 AS patients out of which 5450 were classified as D2M. Extra-axial manifestations such as presence of inflammatory bowel disease, psoriasis and inflammatory eye disease were significantly associated with D2M status whereas comorbidities such as higher BMI, HTN, CKD and depression were higher in this group of patients. Additionally, HLA B27 positivity showed higher odds to be present in D2M disease. The complexity of axSpA lies not only in its heterogeneity of symptoms but factors such as delayed diagnosis and limited treatment options for non-responders. The use of this definition will provide better classification of patients in clinical trials and its use by clinicians will prompt early recognition of disease leading to proactive steps to prevent disease progression, reduce symptoms, and improve quality of life.

A comprehensive management plan for D2M axSpA should include physical therapy, lifestyle modifications, patient education, and support for mental health. Multidisciplinary approaches help maximize functionality, manage pain, and improve overall quality of life for those with complex disease.