This episode deals with the development of a consensus-based expert definition for difficult-to-manage (D2M) axial spondyloarthritis (axSpA), including treatment-refractory (TR) disease. The Assessment of SpondyloArthritisInternational Society (ASAS) spearheaded this effort through a literature review and a two-round Delphi process. The resulting D2M definition encompasses treatment failure, suboptimal disease control, and acknowledgement ofproblematic signs/symptoms by physicians or patients. TRaxSpA falls under this D2M umbrella but requires evidence of treatment failure and objective signs of inflammatory activity. Endorsed by ASAS, the definition aims tostandardize the identification of patients with unmet needs and facilitate further research and improved clinical care in this area.

This episode is based on the publication Poddubnyy D, et al. Ann Rheum Dis 2025

and is developed with NotebookLM.