The Assessment of SpondyloArthritis International Society (ASAS) Consensus-Based Expert Definition of Difficult-to-Manage, including Treatment-Refractory, Axial Spondyloarthritis.

IF 20.6 1区医学 Q1 RHEUMATOLOGY Annals of the Rheumatic Diseases Pub Date : 2025-04-01 Epub Date: 2025-02-14 DOI:10.1016/j.ard.2025.01.035

Denis Poddubnyy, Victoria Navarro-Compán, Murat Torgutalp, Suzanne Arends, Sibel Zehra Aydin, Simone Battista, Filip van den Bosch, Christine Bundy, Alberto Cauli, Jo Davies, Maxime Dougados, Tuncay Duruöz, Bassel El-Zorkany, Warren Fong, Floris van Gaalen, Rodrigo Garcia-Salinas, Marco Garrido Cumbrera, Pál Géher, Lianne Gensler, Simeon Grazio, Feng Huang, Mitsumasa Kishimoto, Robert Landewé, Ying Ying Leung, Pedro M Machado, Helena Marzo-Ortega, Bhowmik Meghnathi, Anna Molto, Elena Nikiphorou, Sofia Ramiro, Martin Rudwaleit, Carla G S Saad, Alexandre Sepriano, James Wei, Xenofon Baraliakos, Désirée van der Heijde

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Abstract

Objectives: To develop a consensus-based expert definition of difficult-to-manage (D2M) axial spondyloarthritis (axSpA), incorporating treatment-refractory (TR) disease.

Methods: A literature review was conducted in 2022 to identify potential definitions for D2M/TR axSpA from prior studies, followed by a 2-round Delphi consensus process conducted in 2022 and 2023 to identify components of D2M axSpA. Based on the results of the Delphi process, a draft of the D2M axSpA definition was developed and presented to the expert task force, including patient representation, and, subsequently, to the Assessment of SpondyloArthritis International Society (ASAS) membership for endorsement in January 2024.

Results: Consensus was reached on a D2M definition encapsulating treatment failure (treatment according to the ASAS-European Alliance of Associations for Rheumatology recommendations and failure of ≥2 biological or targeted synthetic disease-modifying antirheumatic drugs with different mechanisms of action unless contraindicated), suboptimal disease control, and physician or patient acknowledgement of problematic signs/symptoms in patients diagnosed with axSpA by the rheumatologist. This definition represents a broad concept that includes various reasons that lead to an unsatisfactory treatment outcome. TR axSpA is covered by the D2M definition but requires a history of treatment failure, the presence of objective signs of inflammatory activity, and the exclusion of noninflammatory reasons for nonresponse. The proposed D2M definition incorporating TR disease was endorsed by ASAS at the annual meeting in January 2024, with 89% votes (109/123) in favour of it.

Conclusions: The ASAS D2M axSpA definition, including TR disease, allows for identifying patients with unmet needs, paving the way for further research in this condition and its clinical care improvement.

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评估国际协会（ASAS）共识为基础的专家定义难以管理，包括治疗难治性，轴性脊柱炎。

目的：建立一个基于共识的专家定义难治性（D2M）轴性脊柱炎（axSpA），包括难治性（TR）疾病。方法：在2022年进行了一项文献综述，以从先前的研究中确定D2M/TR axSpA的潜在定义，随后在2022年和2023年进行了两轮德尔菲共识过程，以确定D2M axSpA的组成部分。基于德尔菲过程的结果，制定了D2M axSpA定义草案，并提交给专家工作组，包括患者代表，随后提交给国际脊椎关节炎评估协会（ASAS）会员，以便于2024年1月批准。结果：就D2M定义达成共识，包括治疗失败（根据asas -欧洲风湿病协会联盟推荐的治疗和≥2种具有不同作用机制的生物或靶向合成抗风湿药物的失败，除非有禁忌），次理想的疾病控制，以及风湿病学家诊断为axSpA的患者的医生或患者承认有问题的体征/症状。这个定义代表了一个广泛的概念，包括导致治疗结果不满意的各种原因。TR axSpA包含在D2M定义中，但需要有治疗失败史，存在炎症活动的客观迹象，并排除无反应的非炎症原因。合并TR疾病的D2M定义在2024年1月的ASAS年会上获得了89%的赞成票（109/123）。结论：ASAS D2M axSpA定义，包括TR疾病，允许识别未满足需求的患者，为进一步研究该疾病及其临床护理改善铺平道路。

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来源期刊

Annals of the Rheumatic Diseases 医学-风湿病学

CiteScore

35.00

自引率

9.90%

发文量

3728

审稿时长

1.4 months

期刊介绍： Annals of the Rheumatic Diseases (ARD) is an international peer-reviewed journal covering all aspects of rheumatology, which includes the full spectrum of musculoskeletal conditions, arthritic disease, and connective tissue disorders. ARD publishes basic, clinical, and translational scientific research, including the most important recommendations for the management of various conditions.