{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T03:34:23Z","timestamp":1789875263579,"version":"4.0.1"},"reference-count":41,"publisher":"AVES YAYINCILIK A.\u015e.","issue":"3","license":[{"start":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T00:00:00Z","timestamp":1727654400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Archives of Rheumatology"],"abstract":"<jats:p>Objectives: This study aimed to formulate D2T (difficult to treat) criteria for axial spondyloarthritis (AxSpA) patients and identify the prevalence of D2T patients and their characteristics.\r\nPatients and methods: The cross-sectional study was conducted with 166 AxSpA patients (93 males, 73 females; mean age: 47.1\u00b112.9 years; range, 19 to 78 years) between February 2023 and March 2023. The criteria were based on patients treated according to the European Alliance of Associations for Rheumatology (EULAR) recommendations for AxSpA. Entry criteria were treatment failure to \u22652 biological\/targeted synthetic disease-modifying antirheumatic drugs with two different mechanisms of action or \u22653 biological\/targeted synthetic disease-modifying antirheumatic drugs. Potential preliminary factors for D2T criteria were analyzed, and the characteristics of the subjects matching D2T criteria were compared with those of others.\r\nResults: One hundred forty-two ankylosing spondylitis patients and 24 nonradiographic AxSpA patients were included in the study. The rate of fulfilling the D2T criteria was 22.9% (n=38) among AxsPA patients treated with biological agents. The potential D2T criteria were met by 23.2% of ankylosing spondylitis and 20.8% of nonradiographic AxSpA patients. Baseline characteristics, such as sex, age, diagnosis age, occupation, and education, of D2T patients were not statistically different from other patients. The prevalence of fibromyalgia was higher in D2T patients (p<\/jats:p>","DOI":"10.46497\/archrheumatol.2024.10567","type":"journal-article","created":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T07:33:43Z","timestamp":1724830423000},"page":"419-428","source":"Crossref","is-referenced-by-count":13,"title":["Difficult-to-treat axial spondyloarthritis patients"],"prefix":"10.5152","volume":"39","author":[{"family":"Tahir Sayg\u0131n \u00d6\u011f\u00fct","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Funda Erbasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Mehmet Fatih \u015eahiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Mine Nokay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Ay\u015fe Y\u00f6r\u00fck \u00d6\u011f\u00fct","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Melis Dilbil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Mustafa Ender Terzio\u011flu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Veli Yaz\u0131s\u0131z","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3111","published-online":{"date-parts":[[2024,9,30]]},"reference":[{"key":"ref-1","doi-asserted-by":"crossref","unstructured":"Danve A, Deodhar A. 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A new approach to defining disease status in ankylosing spondylitis: The Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994;21:2286-91."},{"key":"ref-18","doi-asserted-by":"crossref","unstructured":"Wendling D, Verhoeven F, Prati C. Is the Difficultto-Treat (D2T) concept applicable to axial spondyloarthritis? Joint Bone Spine 2023;90:105512. doi: 10.1016\/j.jbspin.2022.105512.","DOI":"10.1016\/j.jbspin.2022.105512"},{"key":"ref-19","doi-asserted-by":"crossref","unstructured":"Perrotta FM, Scriffignano S, Ciccia F, Lubrano E. Clinical characteristics of potential \u201cdifficult-totreat\u201d patients with psoriatic arthritis: A retrospective analysis of a longitudinal cohort. Rheumatol Ther 2022;9:1193-201. doi: 10.1007\/s40744-022- 00461-w.","DOI":"10.1007\/s40744-022-00461-w"},{"key":"ref-20","doi-asserted-by":"crossref","unstructured":"Delepine T, Cailliau E, Philippe P, Deprez X, Taisne N, Houvenagel E, et al. Characteristics of difficult to treat axial spondyloarthritis: a comparative analysis. EULAR European Congress of Rheumatology, May 31 - June 03, 2023, Kilchberg, Switzerland: ARD 2023;82(Suppl 1):881-882.","DOI":"10.1136\/annrheumdis-2023-eular.5028"},{"key":"ref-21","doi-asserted-by":"crossref","unstructured":"Costantino F, Aegerter P, Schett G, De Craemer AS, Molto A, Van den Bosch F, et al. Cluster analysis in early axial spondyloarthritis predicts poor outcome in the presence of peripheral articular manifestations. Rheumatology (Oxford) 2022;61:3289-98. doi: 10.1093\/rheumatology\/keab873.","DOI":"10.1093\/rheumatology\/keab873"},{"key":"ref-22","doi-asserted-by":"crossref","unstructured":"Wright GC, Kaine J, Deodhar A. Understanding differences between men and women with axial spondyloarthritis. Semin Arthritis Rheum 2020;50:687- 94. doi: 10.1016\/j.semarthrit.2020.05.005.","DOI":"10.1016\/j.semarthrit.2020.05.005"},{"key":"ref-23","doi-asserted-by":"crossref","unstructured":"Tournadre A, Pereira B, Lhoste A, Dubost JJ, Ristori JM, Claudepierre P, et al. Differences between women and men with recent-onset axial spondyloarthritis: Results from a prospective multicenter French cohort. Arthritis Care Res (Hoboken) 2013;65:1482-9. doi: 10.1002\/acr.22001.","DOI":"10.1002\/acr.22001"},{"key":"ref-24","doi-asserted-by":"crossref","unstructured":"Kenar G, Can G, Cetin P, Yarkan H, Sar\u0131 I, Birlik M, et al. AB0764 gender differences in axial spondyloarthritis. Ann Rheum Dis 2015;74:1154. https:\/\/doi.org\/10.1136\/annrheumdis-2015- eular.5610","DOI":"10.1136\/annrheumdis-2015-eular.5610"},{"key":"ref-25","doi-asserted-by":"crossref","unstructured":"Gracey E, Yao Y, Green B, Qaiyum Z, Baglaenko Y, Lin A, et al. Sexual dimorphism in the Th17 signature of ankylosing spondylitis. Arthritis Rheumatol 2016;68:679-89. doi: 10.1002\/art.39464.","DOI":"10.1002\/art.39464"},{"key":"ref-26","doi-asserted-by":"crossref","unstructured":"de Winter JJ, Paramarta JE, de Jong HM, van de Sande MG, Baeten DL. Peripheral disease contributes significantly to the level of disease activity in axial spondyloarthritis. RMD Open 2019;5:e000802. doi: 10.1136\/rmdopen-2018-000802.","DOI":"10.1136\/rmdopen-2018-000802"},{"key":"ref-27","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-Medina C, Dougados M, Ruyssen-Witrand A, Molt\u00f3 A. Evaluation of concomitant peripheral arthritis in patients with recent onset axial spondyloarthritis: 5-year results from the DESIR cohort. Arthritis Res Ther 2019;21:139. doi: 10.1186\/s13075-019-1927-6.","DOI":"10.1186\/s13075-019-1927-6"},{"key":"ref-28","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-Medina C, Molt\u00f3 A, Dougados M. Peripheral manifestations in spondyloarthritis and their effect: An ancillary analysis of the ASAS-COMOSPA study. J Rheumatol 2020;47:211-7. doi: 10.3899\/ jrheum.181331.","DOI":"10.3899\/jrheum.181331"},{"key":"ref-29","doi-asserted-by":"crossref","unstructured":"Son SM, Kim DS, Lee JS. Fibromyalgia in axial spondyloarthritis: A Meta-analysis. J Clin Rheumatol 2022;28:e222-e227. doi: 10.1097\/ RHU.0000000000001612.","DOI":"10.1097\/RHU.0000000000001612"},{"key":"ref-30","doi-asserted-by":"crossref","unstructured":"\u00d6\u011f\u00fct TS, Erbasan F, Terzio\u011flu ME, Aslan B, \u00c7elik E, Yazisiz V. Neuropathic pain in axial spondyloarthropathy is underdiagnosed and a confounding factor in biologic drug-switching decision: A cross-sectional study. Clin Rheumatol 2023;42:1275-84. doi: 10.1007\/s10067- 023-06531-w.","DOI":"10.1007\/s10067-023-06531-w"},{"key":"ref-31","doi-asserted-by":"crossref","unstructured":"Alunno A, Carubbi F, Stones S, Gerli R, Giacomelli R, Baraliakos X. The impact of fibromyalgia in spondyloarthritis: From classification criteria to outcome measures. Front Med (Lausanne) 2018;5:290. doi: 10.3389\/fmed.2018.00290.","DOI":"10.3389\/fmed.2018.00290"},{"key":"ref-32","doi-asserted-by":"crossref","unstructured":"Kozano\u011flu E, Kelle B, Alayl\u0131 G, Kuru \u00d6, \u00c7ubuk\u00e7u F\u0131rat S, Demir AN, et al. Frequency of fibromyalgianess in patients with rheumatoid arthritis and ankylosing spondylitis: A multicenter study of Turkish League Against Rheumatism (TLAR) network. Arch Rheumatol 2024;39:20-32. doi: 10.46497\/ ArchRheumatol.2023.9925.","DOI":"10.46497\/ArchRheumatol.2023.9925"},{"key":"ref-33","doi-asserted-by":"crossref","unstructured":"Wolfe F. Fibromyalgianess. Arthritis Rheum 2009;61:715-6. doi: 10.1002\/art.24553.","DOI":"10.1002\/art.24553"},{"key":"ref-34","doi-asserted-by":"crossref","unstructured":"Mease PJ. Fibromyalgia, a missed comorbidity in spondyloarthritis: Prevalence and impact on assessment and treatment. 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Ann Rheum Dis 2004;63:665-70. doi: 10.1136\/ard.2003.016386.","DOI":"10.1136\/ard.2003.016386"},{"key":"ref-40","doi-asserted-by":"crossref","unstructured":"van der Heijde D, Kivitz A, Schiff MH, Sieper J, Dijkmans BA, Braun J, et al. Efficacy and safety of adalimumab in patients with ankylosing spondylitis: Results of a multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2006;54:2136-46. doi: 10.1002\/art.21913.","DOI":"10.1002\/art.21913"},{"key":"ref-41","doi-asserted-by":"crossref","unstructured":"Fr\u00f6hlich F, Micheroli R, Hebeisen M, Kissling S, B\u00fcrki K, Exer P, et al. HLA-B27 as a predictor of effectiveness of treatment with TNF inhibitors in axial spondyloarthritis: Data from the Swiss Clinical Quality Management Registry. 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