Difficult-to-treat axial spondyloarthritis — data from real clinical practice

Difficult-to-treat axial spondyloarthritis — data from real clinical practice

I.Z. Gaydukova^1,2, V.I. Mazurov^1,2, E.A. Trofimov^1,2, O.V. Inamova^1,2, A.L. Chudinov^1,2, R.R. Samigullina¹, E.P. Filonenko¹, A.L. Burulev1,2

¹I.I. Mechnikov North-Western State Medical University, St. Petersburg

²V.A. Nasonova St. Petersburg Clinical Rheumatology Hospital, St. Petersburg

Aim: to delineate the clinical profile of patients with difficult-to-treat (D2T) axial spondyloarthritis (AxSpA) using the real clinical practice data, and to analyze contributing factors to these treatment challenges.

Patients and Methods: a total of 53 remote consultations were conducted for patients with suspected or diagnosed AxSpA, as referred by local physicians. These cases were classified as "difficult to diagnose and/or treat" by the attending healthcare providers at the patient’s place of residence, necessitating specialist consultation.

Results: diagnostic challenges accounted for 40% of the consultations, while therapy modifications were necessary in 60% of cases. Non-pathogenic AxSpA was commonly mistaken for degenerative disc disease (DDD) or a combination of DDD with myofascial pain syndrome. Misdiagnoses at the referring centers were frequently due to inadequate documentation of symptoms and medical history (60%), misinterpretation of imaging results (20%), overemphasis on HLA-B27 antigen presence (10%), and neglecting non-SpA causes of pain or laboratory anomalies (70% of cases). Commonly, patients were administered nonsteroidal anti-inflammatory drugs (NSAIDs), with less frequent prescriptions of glucocorticoids, conventional disease-modifying anti-rheumatic drugs (DMARDs), and genetically engineered biological or targeted drugs (GEBTs). NSAID regimens were most frequently adjusted, while modifications to basic pharmaceuticals were less common. Of the 50 patients evaluated for GEBTs, 17 (34%) were advised to initiate such therapies for the first time. An objectively challenging clinical presentation, difficult to manage at regional or primary and secondary health care levels, necessitated Federal Center remote consultations in 58% of cases.

Conclusion: the management of AxSpA in clinical practice is hindered by the lack of a standardized diagnostic pathway, delayed referrals to primary care and rheumatology specialists, and the presence of significant non-inflammatory components contributing to persistent pain, compounded by comorbid conditions.

Keywords: axial spondyloarthritis, ankylosing spondylitis, Bechterew’s disease, difficult-to-treat, D2T, genetically engineered biological therapy.

For citation: Gaydukova I.Z., Mazurov V.I., Trofimov E.A., Inamova O.V., Chudinov A.L., Samigullina R.R., Filonenko E.P., Burulev A.L. Difficult-to-treat axial spondyloarthritis — data from real clinical practice. RMJ. 2024;8:8–16.