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Background <p>Difficult to manage (D2M) axial spondyloarthritis (axSpA) is an evolving clinical concept. We aimed to assess the prevalence, predictors and long-term outcomes of D2M axSpA.</p> Methods <p>Prospective single center cohort study of axSpA patients starting targeted agents (01/01/2007 until 28/02/2024). The ASAS criteria were applied to classify D2M. Baseline parameters were assessed as predictors of D2M development by multivariate logistic regression models. To identify comorbidity clusters and their contribution to D2M, a K-means cluster analysis on binary indicators of most prevalent chronic illnesses was performed. Long-term functional evolution and adverse events’ rate were compared between D2M and non-D2M.</p> Results <p>Out of 434 patients, 50 (11.5%) developed D2M disease. Compared to non-D2M, they had higher disease activity at baseline (<i>p</i> = 0.01) and failed to improve at 6 months (<i>p</i> &lt; 0.0001), while dyslipidemia, osteoarthritis and fibromyalgia were more prevalent (<i>p</i> &lt; 0.0001). Independent predictors for developing D2M axSpA were the presence of fibromyalgia (OR 3.55), osteoporosis (OR 5.67) and dyslipidemia (OR 2.70), while two clusters of comorbidities (“chronic pain syndromes” and “metabolic”) significantly contributed to D2M (OR 2.52 and OR 3.30; <i>p</i> = 0.010 and 0.013 respectively). During a total follow-up period of 2312 patient-years, D2M patients developed higher functional impairment and had more serious adverse events and hospitalizations (<i>p</i> = 0.016) compared to non-D2M patients.</p> Conclusion <p>11.5% of axSpA patients developed D2M disease and showed adverse long-term outcome compared to non-D2M. While D2M patients had at baseline higher disease’s burden, comorbidities mostly related to chronic pain syndromes predicted D2M development, supporting their significance for D2M axSpA evolution.</p>

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Difficult to manage axial spondyloarthritis patients have high burden of pain-related comorbidities and adverse long-term outcome

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月24日

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  • Antonios Bertsias,
  • Irini Flouri,
  • Evgenia Emmanouilidou,
  • Argyro Repa,
  • Nestor Avgoustidis,
  • Eleni Kalogiannaki,
  • Sofia Pitsigavdaki,
  • Georgios Bertsias,
  • Prodromos Sidiropoulos

摘要

Background

Difficult to manage (D2M) axial spondyloarthritis (axSpA) is an evolving clinical concept. We aimed to assess the prevalence, predictors and long-term outcomes of D2M axSpA.

Methods

Prospective single center cohort study of axSpA patients starting targeted agents (01/01/2007 until 28/02/2024). The ASAS criteria were applied to classify D2M. Baseline parameters were assessed as predictors of D2M development by multivariate logistic regression models. To identify comorbidity clusters and their contribution to D2M, a K-means cluster analysis on binary indicators of most prevalent chronic illnesses was performed. Long-term functional evolution and adverse events’ rate were compared between D2M and non-D2M.

Results

Out of 434 patients, 50 (11.5%) developed D2M disease. Compared to non-D2M, they had higher disease activity at baseline (p = 0.01) and failed to improve at 6 months (p < 0.0001), while dyslipidemia, osteoarthritis and fibromyalgia were more prevalent (p < 0.0001). Independent predictors for developing D2M axSpA were the presence of fibromyalgia (OR 3.55), osteoporosis (OR 5.67) and dyslipidemia (OR 2.70), while two clusters of comorbidities (“chronic pain syndromes” and “metabolic”) significantly contributed to D2M (OR 2.52 and OR 3.30; p = 0.010 and 0.013 respectively). During a total follow-up period of 2312 patient-years, D2M patients developed higher functional impairment and had more serious adverse events and hospitalizations (p = 0.016) compared to non-D2M patients.

Conclusion

11.5% of axSpA patients developed D2M disease and showed adverse long-term outcome compared to non-D2M. While D2M patients had at baseline higher disease’s burden, comorbidities mostly related to chronic pain syndromes predicted D2M development, supporting their significance for D2M axSpA evolution.