Experts are working to define “difficult-to-treat” patients with axial spondyloarthritis and psoriatic arthritis who struggle to reach remission despite advanced treatments. Current guidelines lack clear guidance on managing these patients, with various factors contributing to treatment resistance, including noninflammatory causes of pain. Efforts by international groups like ASAS and GRAPPA aim to develop consensus definitions for these patients. Definitions include criteria for treatment failure, signs of disease activity, and difficulty in tapering steroid treatment. These definitions will guide future clinical trials and help clinicians differentiate between true biologically refractory inflammatory disease and nonresponders with diverse issues.
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Defining Difficult-to-Treat axSpA and PsA
