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A mixed methods design was applied. Patients with axSpA who visited the outpatient clinic with active disease (AxSpA Disease Activity Score [ASDAS]\u2009\u2265\u20092.1), but did not receive a treatment adjustment, were identified. These patient cases were discussed in individual semi-structured interviews with the respective treating rheumatologists, and a subgroup of these patients was also interviewed. In parallel, all interviewed participants completed a quantitative survey. Qualitative and quantitative data were analysed thematically and descriptively, respectively. Twenty-three patients were discussed with 11 rheumatologists, and 16 of these patients were interviewed personally. Barriers to T2T included challenges in the measurement of inflammatory disease activity using the ASDAS, and numerous patient-related factors such as concern about treatment adaptations. The limited number of viable treatment options and scarce amount of evidence supporting T2T in axSpA, as well as logistical challenges, were additional obstacles. Facilitators included patients\u2019 broad knowledge about axSpA, rheumatologists\u2019 awareness of T2T recommendations, and positive doctor-patient relationships with the application of shared decision-making. Moreover, a supporting infrastructure, such as one with high accessibility to the outpatient clinic between scheduled visits, was considered necessary for the application of a T2T strategy. In conclusion, numerous barriers and facilitators to the implementation of a T2T strategy in axSpA are present, which need to be considered when applying this treatment approach in clinical practice.<\/jats:p>","DOI":"10.1007\/s00296-025-05795-6","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T05:59:44Z","timestamp":1738303184000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Barriers and facilitators to treat-to-target in axial spondyloarthritis in clinical practice: a mixed methods study"],"prefix":"10.1007","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0039-493X","authenticated-orcid":false,"given":"Marius L.","family":"Smits","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3011-8547","authenticated-orcid":false,"given":"Casper","family":"Webers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8704-5783","authenticated-orcid":false,"given":"Mirte","family":"van Dooren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6833-3157","authenticated-orcid":false,"given":"Elien A. 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The Medical Research Ethics Committee of the Academic Hospital Maastricht\/Maastricht University determined that the Dutch Medical Research Involving Human Subjects Act was non-applicable to this study (METC azM\/UM 2023-0213). All participants provided informed consent for their provided data to be used for research purposes.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No part of this manuscript, including text and graphics, are copied or published elsewhere in whole or in part.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}},{"value":"This work has previously been presented as poster presentations at the EULAR 2024 Congress (Vienna, Austria, 2024), 14th International Congress on Spondyloarthritides (Ghent, Belgium, 2024) and Dutch Society for Rheumatology Najaarsdagen 2024 (Arnhem, The Netherlands, 2024). Abstracts have been published in Annals of the Rheumatic Diseases (, abstract number: POS0802) and Clinical and Experimental Rheumatology (, abstract number: P101).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Note on related congress abstracts and publication"}},{"value":"MS has received honoraria from Novartis. CW has received honoraria from Novartis. MvD declares no competing interests. EM has received research grants from AbbVie, Eli Lilly, Novartis, Pfizer and UCB. JV has received honoraria from Eli Lilly. AvT has received research grants from Novartis, Pfizer and UCB, consulting fees from Novartis, Galapagos, Johnson and Johnson and UCB, travel support from AbbVie, and speaker fees from Pfizer and Novartis.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"41"}}