Olivier Fakih, MD, MPH: Nationwide Data on Comorbidities of Axial Spondyloarthritis

In this HCPLive interview, Olivier Fakih, MD, MPH, discussed his team’s findings presented at the American College of Rheumatology’s 2023 Convergence from a nationwide study in France on difficult-to-treat axial spondyloarthritis.

With a growing array of targeted therapies for spondyloarthritis treatment, the persistence of active disease in certain individuals has given rise to the concept of difficult-to-treat axial spondyloarthritis (D2T-axSpA), mirroring analogous considerations in rheumatoid arthritis (D2T-RA). His team sought to look at the cumulative incidence of D2T-axSpA and identify associated factors.

“So this study is based on the Système National des Données de Santé, which is a large database containing all data from the National Health Insurance in France,” Fakih said. “It's a medical administrative database, so we do not have any clinical info. We only have data regarding treatment, reimbursement of treatments, hospitalizations, and long term illnesses, which is a big program in France for chronic diseases.”

Fakih explained that ‘difficult-to-treat’ is a relatively new concept in rheumatology, though he adds that failure of treatments is not the only qualification criteria.

“It's another chronic, inflammatory rheumatic disease, and there is a definition which is commonly shared by everyone from the EULAR, the European Association of Rheumatology, and in these definitions, are 3 criteria,” Fakih said. “The first one is a failure of multiple lines of treatments. The second one is objective signs of activity of the inflammatory rheumatic disease. The third one is the perception of difficult-to-treat rheumatism by the patient or the clinician.”

In this study, Fakih’s team found a substantial association between difficult-to-treat axial spondyloarthritis and multiple comorbidities such as psoriasis, hypertension and depression.

“There are some comorbidities which are already known to be associated with an active disease, for example,” Fakih said. “But it's the first time that we show there is an association really difficult to treat, as per the definition in spondyloarthritis. I think this is important for the management of patients, because I think the clinicians have to really consider the comorbidities of patients when initiating treatments, especially if a patient has psoriasis or hypertension or even depression.”

To find out more from Fakih’s findings, view the full interview segment posted above.

The quotes contained in this description were edited for clarity.