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

2025-04Artigo científico Acesso aberto
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dc.contributor.authorPoddubnyy, Denis
dc.contributor.authorPoddubnyy, Denis
dc.contributor.authorNavarro-Compán, Victoria
dc.contributor.authorNavarro-Compán, Victoria
dc.contributor.authorTorgutalp, Murat
dc.contributor.authorTORGUTALP, MURAT
dc.contributor.authorArends, Suzanne
dc.contributor.authorArends, Suzanne
dc.contributor.authorAydin, Sibel Zehra
dc.contributor.authorAydin, Sibel Zehra
dc.contributor.authorBattista, Simone
dc.contributor.authorBattista, Simone
dc.contributor.authorvan den Bosch, Filip
dc.contributor.authorVan Den Bosch, Filip
dc.contributor.authorBundy, Christine
dc.contributor.authorBundy, Christine
dc.contributor.authorCauli, Alberto
dc.contributor.authorCAULI, ALBERTO
dc.contributor.authorDavies, Jo
dc.contributor.authorDougados, Maxime
dc.contributor.authorDougados, Maxime
dc.contributor.authorDuruöz, Tuncay
dc.contributor.authorDuruöz, Mehmet Tuncay
dc.contributor.authorEl-Zorkany, Bassel
dc.contributor.authorElzorkany, Bassel
dc.contributor.authorFong, Warren
dc.contributor.authorFong, Warren
dc.contributor.authorvan Gaalen, Floris
dc.contributor.authorGarcia-Salinas, Rodrigo
dc.contributor.authorGarrido Cumbrera, Marco
dc.contributor.authorGéher, Pál
dc.contributor.authorGensler, Lianne
dc.contributor.authorGrazio, Simeon
dc.contributor.authorHuang, Feng
dc.contributor.authorKishimoto, Mitsumasa
dc.contributor.authorLandewé, Robert
dc.contributor.authorLeung, Ying Ying
dc.contributor.authorMachado, Pedro M.
dc.contributor.authorMarzo-Ortega, Helena
dc.contributor.authorMeghnathi, Bhowmik
dc.contributor.authorMolto, Anna
dc.contributor.authorNikiphorou, Elena
dc.contributor.authorRamiro, Sofia
dc.contributor.authorRamiro, Sofia
dc.contributor.authorRudwaleit, Martin
dc.contributor.authorSaad, Carla G.S.
dc.contributor.authorSepriano, Alexandre
dc.contributor.authorSepriano, Alexandre
dc.contributor.authorWei, James
dc.contributor.authorBaraliakos, Xenofon
dc.contributor.authorvan der Heijde, Désirée
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblBMJ Publishing Group
dc.date.accessioned2025-03-27T21:11:51Z
dc.date.available2025-03-27T21:11:51Z
dc.date.issued2025-04
dc.descriptionPublisher Copyright: © 2025 The Author(s)
dc.description.abstractObjectives: 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.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent1191693
dc.identifier.doi10.1016/j.ard.2025.01.035
dc.identifier.issn0003-4967
dc.identifier.otherPURE: 111300003
dc.identifier.otherPURE UUID: 71d8d78a-60cd-4db5-b092-1a58fdfa17fc
dc.identifier.otherScopus: 85217911457
dc.identifier.urihttp://hdl.handle.net/10362/181539
dc.identifier.urlhttps://www.scopus.com/pages/publications/85217911457
dc.language.isoeng
dc.peerreviewedyes
dc.subjectRheumatology
dc.subjectImmunology and Allergy
dc.subjectImmunology
dc.subjectGeneral Biochemistry,Genetics and Molecular Biology
dc.titleThe Assessment of SpondyloArthritis International Society (ASAS) Consensus-Based Expert Definition of Difficult-to-Manage, including Treatment-Refractory, Axial Spondyloarthritisen
dc.typejournal article
degois.publication.firstPage538
degois.publication.issue4
degois.publication.lastPage546
degois.publication.titleAnnals of the rheumatic diseases
degois.publication.volume84
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