Associated factors of difficult-to-treat spondyloarthritis

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Published May 24, 2026
https://doi.org/10.62438/tunismed.v104i05.6683
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Vol. 104 No. 05 (2026): Tunis Med May 2026

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Séiny Kanta
Rheumatology Department, Mohammed V Military Teaching Hospital – PO Box 1018, Rabat; Faculty of Medicine and Pharmacy, PO Box 6203, Rabat Institute, Mohammed V University, Rabat, Morocco.
Najlae El Ouardi
Rheumatology Department, Mohammed V Military Teaching Hospital – PO Box 1018, Rabat; Faculty of Medicine and Pharmacy, PO Box 6203, Rabat Institute, Mohammed V University, Rabat, Morocco.
Mahamadou Sagara
Rheumatology Department, Mohammed V Military Teaching Hospital – PO Box 1018, Rabat; Faculty of Medicine and Pharmacy, PO Box 6203, Rabat Institute, Mohammed V University, Rabat, Morocco.
Houda El Assad
Rheumatology Department, Mohammed V Military Teaching Hospital – PO Box 1018, Rabat; Faculty of Medicine and Pharmacy, PO Box 6203, Rabat Institute, Mohammed V University, Rabat, Morocco.
Hajar Zouaki
Rheumatology Department, Mohammed V Military Teaching Hospital – PO Box 1018, Rabat; Faculty of Medicine and Pharmacy, PO Box 6203, Rabat Institute, Mohammed V University, Rabat, Morocco.
El Kacem El Marbouh
Rheumatology Department, Mohammed V Military Teaching Hospital – PO Box 1018, Rabat; Faculty of Medicine and Pharmacy, PO Box 6203, Rabat Institute, Mohammed V University, Rabat, Morocco.
Alassane Alidou Garba
Rheumatology Department, Mohammed V Military Teaching Hospital – PO Box 1018, Rabat; Faculty of Medicine and Pharmacy, PO Box 6203, Rabat Institute, Mohammed V University, Rabat, Morocco.
Abdellah Ould Mohamed
Rheumatology Department, Mohammed V Military Teaching Hospital – PO Box 1018, Rabat; Faculty of Medicine and Pharmacy, PO Box 6203, Rabat Institute, Mohammed V University, Rabat, Morocco.
Laila Taoubane
Rheumatology Department, Mohammed V Military Teaching Hospital – PO Box 1018, Rabat; Faculty of Medicine and Pharmacy, PO Box 6203, Rabat Institute, Mohammed V University, Rabat, Morocco.
Abderrahim Majjad
Rheumatology Department, Mohammed V Military Teaching Hospital – PO Box 1018, Rabat; Faculty of Medicine and Pharmacy, PO Box 6203, Rabat Institute, Mohammed V University, Rabat, Morocco.
Hamza Toufik
Rheumatology Department, Mohammed V Military Teaching Hospital – PO Box 1018, Rabat; Faculty of Medicine and Pharmacy, PO Box 6203, Rabat Institute, Mohammed V University, Rabat, Morocco.
Ahmed Bezza
Rheumatology Department, Mohammed V Military Teaching Hospital – PO Box 1018, Rabat; Faculty of Medicine and Pharmacy, PO Box 6203, Rabat Institute, Mohammed V University, Rabat, Morocco.

Abstract

Introduction: Biotherapies have revolutionised the management of spondyloarthritis (SpA). Despite these advances, there is still a proportion of patients with multiple changes in biological markers, which may correspond to difficult-to-treat spondyloarthritis (SPA D2T). Our study aims to
explore the prevalence of this particular entity and to characterise its clinical aspects in a Moroccan population.
Methods: This is a comparative cross-sectional study that included patients with SpA admitted to the department on biologic therapies. Sociodemographic, comorbidity, clinical, paraclinical and therapeutic data were collected. Patients who had received at least two biologics were considered to be SpA D2T. A comparison was made with a control group of non-multi-switchers (SpA-non-D2T).
Results: 210 patients were included, 56.2% of whomwere men. The prevalence of multi-switchers was 32,7%. D2T SpA patients were predominantly female (53,6% versus 39%, p= 0,04), had more axial involvement (76,8% versus 91,5%, p= 0,003), CsDMARD use (97,1% versus 31,9%, p= < 0,001).
Disease activity at the initiation of biotherapy was higher in D2T-ASDs. The time between diagnosis and use of the first biologic was longer (4[2,25–6] years versus 3 [1–4] years, p = 0,03). All D2T-SPA patients had received anti-TNFα.
Conclusion: Our study found a high prevalence of D2T-SpA.

Keywords:

Spondyloarthritis, Targeted therapy, Difficult to treat, Associated factors

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