Disease-related and psychosocial factors associated with difficult-to-manage and treatment-refractory axial spondyloarthritis: insights from the Greek AxSpA Registry.
Article in Rheumatology international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
2 · The registry
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
5 · Who and what money
Authors and funding
38 authors.
N KougkasFourth Department of Internal Medicine, Medical School, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. nkougas@yahoo.gr.ORCID http://orcid.org/0000-0001-5275-8639
Konstantinos TsafisFourth Department of Internal Medicine, Medical School, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.ORCID http://orcid.org/0009-0005-3386-597X
Dimitrios DeligeorgakisFourth Department of Internal Medicine, Medical School, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.ORCID http://orcid.org/0000-0002-1379-4888
Vassileios PapadopoulosLaboratory of Anatomy, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.ORCID http://orcid.org/0000-0002-4188-9518
Nikolaos FytanidisFirst Department of Internal Medicine, Department of Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.ORCID http://orcid.org/0009-0000-9523-3015
Nikolaos KoletsosDepartment of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.ORCID http://orcid.org/0000-0001-6976-2802
Evripidis KaltsonoudisDepartment of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.ORCID http://orcid.org/0000-0002-7212-0533
P V VoulgariDepartment of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.ORCID http://orcid.org/0000-0002-5193-2284
Anastasios KaramanakosJoint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, School of Medicine, General Hospital of Athens "Laiko", National and Kapodistrian University of Athens, Athens, Greece.ORCID http://orcid.org/0000-0002-3006-9362
Maria PappaJoint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, School of Medicine, General Hospital of Athens "Laiko", National and Kapodistrian University of Athens, Athens, Greece.ORCID http://orcid.org/0000-0003-1296-0693
Maria G TektonidouJoint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, School of Medicine, General Hospital of Athens "Laiko", National and Kapodistrian University of Athens, Athens, Greece.ORCID http://orcid.org/0000-0003-2238-0975
P P SfikakisJoint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, School of Medicine, General Hospital of Athens "Laiko", National and Kapodistrian University of Athens, Athens, Greece.ORCID http://orcid.org/0000-0001-5484-2930
Evgenia MavreaJoint Academic Rheumatology Program, Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, School of Medicine, National and Kapodistrian University of Athens, General Hospital of Athens "Hippokration", Athens, 2nd, Greece.ORCID http://orcid.org/0009-0007-6832-9688
Christos KoutsianasJoint Academic Rheumatology Program, Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, School of Medicine, National and Kapodistrian University of Athens, General Hospital of Athens "Hippokration", Athens, 2nd, Greece.ORCID http://orcid.org/0000-0002-6621-6918
Elena SampatakakiJoint Academic Rheumatology Program, Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 4th, Greece.ORCID http://orcid.org/0009-0006-9009-0784
Konstantina ZoupidouJoint Academic Rheumatology Program, Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 4th, Greece.ORCID http://orcid.org/0009-0008-5708-7182
Pelagia KatsimbriJoint Academic Rheumatology Program, Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 4th, Greece.ORCID http://orcid.org/0000-0002-7634-6863
Georgios IliopoulosDepartment of Rheumatology, Medical School, Patras University Hospital, University of Patras, Patras, Greece.ORCID http://orcid.org/0000-0001-9857-0842
Dimitrios DaoussisDepartment of Rheumatology, Medical School, Patras University Hospital, University of Patras, Patras, Greece.ORCID http://orcid.org/0000-0001-8027-3655
Theodoros DimitroulasFourth Department of Internal Medicine, Medical School, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.ORCID http://orcid.org/0000-0002-0364-1642
Dimitrios VassilopoulosJoint Academic Rheumatology Program, Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, School of Medicine, National and Kapodistrian University of Athens, General Hospital of Athens "Hippokration", Athens, 2nd, Greece.ORCID http://orcid.org/0000-0003-2288-3863
G E Fragoulis *Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, School of Medicine, General Hospital of Athens "Laiko", National and Kapodistrian University of Athens, Athens, Greece.ORCID http://orcid.org/0000-0003-4932-7023
Charalampos Papagoras *First Department of Internal Medicine, Department of Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.ORCID http://orcid.org/0000-0001-6207-496X
Funding
Hellenic Rheumatology Society Hellenic Rheumatology Society
6 · The paper itself
Abstract
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.
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.
Disease-related and psychosocial factors associated with difficult-to-manage and treatment-refractory axial spondyloarthritis: insights from the Greek AxSpA Registry. · full record | OpenQuestion