ArticleRheumatology (Oxford, England)2025
Exploring difficult-to-manage axial spondyloarthritis: results from a Dutch clinical practice registry.
Article in Rheumatology (Oxford, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Observational
- Difficult-to-treat, complex-to-manage, treatment-refractory spondyloarthritis: semantics or substance?Current opinion in rheumatology · 2026Review
- Disease-related and psychosocial factors associated with difficult-to-manage and treatment-refractory axial spondyloarthritis: insights from the Greek AxSpA Registry.Rheumatology international · 2026Article
- Spondyloarthritis and inflammatory bowel disease: towards a more severe and refractory disease phenotype.EULAR rheumatology open · 2026Article
- Prevalence and risk factors of difficult-to-treat axial spondyloarthritis: Real-life evidence from the BioSTaR database.Clinical rheumatology · 2026Observational
- Difficult to manage axial spondyloarthritis patients have high burden of pain-related comorbidities and adverse long-term outcome.Arthritis research & therapy · 2026Article
- Frequency of difficult-to-manage and treatment-refractory axial SpA: insights from the German RABBIT-SpA register using recent ASAS definitions.Rheumatology (Oxford, England) · 2026Article
- Prevalence and clinical factors associated with difficult-to-manage axial spondyloarthritis: a multicentre Italian cohort study with meta-analysis.Therapeutic advances in musculoskeletal disease · 2026Article
- Early identification of difficult-to-manage axial spondyloarthritis using machine-learning decision trees.Therapeutic advances in musculoskeletal disease · 2026Article
- Patients with poorer health status are more likely to have difficult-to-manage axial spondyloarthritis: insights from a real-world cohort.Therapeutic advances in musculoskeletal disease · 2026Article
- Difficult-to-Manage Axial Spondyloarthritis According to ASAS Criteria in Reuma-Check Cohort: Frequency, Predictive Factors, and Treatment Patterns.Clinical rheumatology · 2025Observational
- The treatment landscape in axial spondyloarthritis-do we need new therapies?EULAR rheumatology open · 2025Review
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Authors and funding
4 authors.
Funding
Abstract
objectivesTo explore (1) the prevalence of difficult-to-manage axial spondyloarthritis (D2M axSpA) in clinical practice according to the Assessment of SpondyloArthritis international Society (ASAS) definition, (2) specific components of this definition contributing most to its fulfilment and (3) associated patient characteristics.
methodsThis cross-sectional study used data from the SpA-Net registry. Fulfilling the ASAS definition required: (1) treatment failure, (2) insufficient disease control (any of: [A] high disease activity (AxSpA Disease Activity Score [ASDAS] ≥2.1), [B] signs of active disease (e.g. peripheral manifestations) or [C] reduced health-related quality of life) and (3) a problematic management situation in the patient's or rheumatologist's perspective. Three variations of the ASAS definition were investigated, including only subcriterion A, B or C in domain 2. Treatment-refractory axSpA required fulfilment of the primary ASAS definition, an ASDAS ≥2.1 and CRP ≥5 mg/L. The prevalence of D2M axSpA per explored definition was calculated, and associated characteristics were assessed using logistic regression analyses.
resultsData from 263 patients were analysed. Overall, 9.7% had D2M axSpA (variations A-C: 3.6-8.7%) and 1.7% had treatment-refractory disease. 'Treatment failure' affected 9.9-11.6% of patients, 'insufficient disease control' affected 79.7% of patients (variation A: 57.0%, B: 44.6%, C: 51.4%) and 'problematic management' affected 51.4-60.2% of patients. Current smoking (OR = 3.1 [95% CI 1.1-8.7]) and a history of psoriasis (OR = 2.8 [95% CI 1.0-7.6]) were associated characteristics.
conclusionOne in 10 patients with axSpA have D2M disease. Patient-reported outcomes contribute importantly to the classification of D2M axSpA. Current smoking and a history of psoriasis are associated characteristics.
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