Difficult-to-treat Spondyloarthritis: What Are the Associated Factors

Séiny Kanta; Najlae El Ouardi; Mahamadou Sagara; Hajar Zouaki; Houda El Assad; Alassane Alidou Garba; El Kacem El Marbouh; Laila Taoubane; Abderrahim Majjad; Hamza Toufik; Ahmed Bezza

doi:doi:10.11648/j.sjcm.20251404.13

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Difficult-to-treat Spondyloarthritis: What Are the Associated Factors

Séiny Kanta^*

, Najlae El Ouardi

, Mahamadou Sagara

, Hajar Zouaki

, Houda El Assad

, Alassane Alidou Garba

, El Kacem El Marbouh

, Laila Taoubane

, Abderrahim Majjad

, Hamza Toufik

, Ahmed Bezza

Published in Science Journal of Clinical Medicine (Volume 14, Issue 4)

Received: 27 October 2025 Accepted: 10 November 2025 Published: 31 December 2025

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Abstract

Introduction: There have been significant advances in the treatment of spondylarthritis (SpA) in recent years. Despite these advances, there is still a proportion of patients who experience multiple changes in biologic, which may correspond to difficult-to-treat spondylarthritis (SPA DaT). Unlike rheumatoid arthritis, there is no consensus definition for this concept. The aim of our study is to determine the prevalence of multi-switchers with spondylarthritis, identify their characteristics, and analyse the number and reasons for switching in a Moroccan population. Patients and methods: This is a comparative cross-sectional study that included patients with SpA diagnosed according to the 2009 ASAS criteria admitted to our department for targeted treatment. Sociodemographic data, comorbidities, and clinical, paraclinical, and therapeutic characteristics were collected for each patient. Multi-switchers who had received at least two biologics were considered to be SpA DaT. Their prevalence was estimated, and a comparison was made with a control group of non-multi-switchers (SpA-non-DaT). Results: Two hundred and ten patients were included, 56.2% of whom were men, 63% with a long average disease duration. The prevalence of multi-switchers was 32.7%. Compared to the control group, patients in the DaT group were predominantly female (53.6% versus 39%, p=0.04), had more axial involvement (76.8% versus 91.5%, p=0.003) and peripheral joint involvement (88.4% versus 67.4%, p= 0.001) and associated fibromyalgia (33.3% versus 66.7%, p = 0.980), CsDMARD use (97.1% versus 31.9%, p= < 0.001), and corticosteroid use (34.8% versus 11.3%, p= < 0.001). Disease activity, BASDAI, ASDAS and CRP at the start of biotherapy were higher in the SPA DaT group (BASDAI: 21.8% versus 20.6%, p=0.08), (ASDAS: 46.4% versus 54.6%, p = 0.03), BASFI (27.5% versus 41.8% p=0.04) CRP (: 14.19±4.73 mg/l versus 13.7±2.1 mg/l, p = 0.01). Similarly, 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 patients in the DaT group had received anti-TNFα, and 22.9% had received anti-IL17. Analysing switches between biologics in this difficult-to-treat group, the first switch was linked to primary failure in 59% of cases, secondary failure in 29% of cases, and an adverse effect in 12% of cases. In the second switch, primary and secondary failure were observed in 64% and 33% of cases, respectively, and adverse effects in 3%. Regarding the third switch, 83% had primary failure and 17% had secondary failure. Conclusion: This study reveals a significant prevalence of patients with multiple treatment changes in the Moroccan population, highlighting the need for a larger patient sample to better define this condition.

Published in	Science Journal of Clinical Medicine (Volume 14, Issue 4)
DOI	10.11648/j.sjcm.20251404.13
Page(s)	95-100
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Spondylarthritis, Targeted Treatment, Difficult to Treat, Definition, Associated Factors

References

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APA Style

Kanta, S., Ouardi, N. E., Sagara, M., Zouaki, H., Assad, H. E., et al. (2025). Difficult-to-treat Spondyloarthritis: What Are the Associated Factors. Science Journal of Clinical Medicine, 14(4), 95-100. https://doi.org/10.11648/j.sjcm.20251404.13

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ACS Style

Kanta, S.; Ouardi, N. E.; Sagara, M.; Zouaki, H.; Assad, H. E., et al. Difficult-to-treat Spondyloarthritis: What Are the Associated Factors. Sci. J. Clin. Med. 2025, 14(4), 95-100. doi: 10.11648/j.sjcm.20251404.13

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AMA Style

Kanta S, Ouardi NE, Sagara M, Zouaki H, Assad HE, et al. Difficult-to-treat Spondyloarthritis: What Are the Associated Factors. Sci J Clin Med. 2025;14(4):95-100. doi: 10.11648/j.sjcm.20251404.13

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@article{10.11648/j.sjcm.20251404.13,
  author = {Séiny Kanta and Najlae El Ouardi and Mahamadou Sagara and Hajar Zouaki and Houda El Assad and Alassane Alidou Garba and El Kacem El Marbouh and Laila Taoubane and Abderrahim Majjad and Hamza Toufik and Ahmed Bezza},
  title = {Difficult-to-treat Spondyloarthritis: What Are the Associated Factors},
  journal = {Science Journal of Clinical Medicine},
  volume = {14},
  number = {4},
  pages = {95-100},
  doi = {10.11648/j.sjcm.20251404.13},
  url = {https://doi.org/10.11648/j.sjcm.20251404.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjcm.20251404.13},
  abstract = {Introduction: There have been significant advances in the treatment of spondylarthritis (SpA) in recent years. Despite these advances, there is still a proportion of patients who experience multiple changes in biologic, which may correspond to difficult-to-treat spondylarthritis (SPA DaT). Unlike rheumatoid arthritis, there is no consensus definition for this concept. The aim of our study is to determine the prevalence of multi-switchers with spondylarthritis, identify their characteristics, and analyse the number and reasons for switching in a Moroccan population. Patients and methods: This is a comparative cross-sectional study that included patients with SpA diagnosed according to the 2009 ASAS criteria admitted to our department for targeted treatment. Sociodemographic data, comorbidities, and clinical, paraclinical, and therapeutic characteristics were collected for each patient. Multi-switchers who had received at least two biologics were considered to be SpA DaT. Their prevalence was estimated, and a comparison was made with a control group of non-multi-switchers (SpA-non-DaT). Results: Two hundred and ten patients were included, 56.2% of whom were men, 63% with a long average disease duration. The prevalence of multi-switchers was 32.7%. Compared to the control group, patients in the DaT group were predominantly female (53.6% versus 39%, p=0.04), had more axial involvement (76.8% versus 91.5%, p=0.003) and peripheral joint involvement (88.4% versus 67.4%, p= 0.001) and associated fibromyalgia (33.3% versus 66.7%, p = 0.980), CsDMARD use (97.1% versus 31.9%, p= Conclusion: This study reveals a significant prevalence of patients with multiple treatment changes in the Moroccan population, highlighting the need for a larger patient sample to better define this condition.},
 year = {2025}
}

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TY  - JOUR
T1  - Difficult-to-treat Spondyloarthritis: What Are the Associated Factors
AU  - Séiny Kanta
AU  - Najlae El Ouardi
AU  - Mahamadou Sagara
AU  - Hajar Zouaki
AU  - Houda El Assad
AU  - Alassane Alidou Garba
AU  - El Kacem El Marbouh
AU  - Laila Taoubane
AU  - Abderrahim Majjad
AU  - Hamza Toufik
AU  - Ahmed Bezza
Y1  - 2025/12/31
PY  - 2025
N1  - https://doi.org/10.11648/j.sjcm.20251404.13
DO  - 10.11648/j.sjcm.20251404.13
T2  - Science Journal of Clinical Medicine
JF  - Science Journal of Clinical Medicine
JO  - Science Journal of Clinical Medicine
SP  - 95
EP  - 100
PB  - Science Publishing Group
SN  - 2327-2732
UR  - https://doi.org/10.11648/j.sjcm.20251404.13
AB  - Introduction: There have been significant advances in the treatment of spondylarthritis (SpA) in recent years. Despite these advances, there is still a proportion of patients who experience multiple changes in biologic, which may correspond to difficult-to-treat spondylarthritis (SPA DaT). Unlike rheumatoid arthritis, there is no consensus definition for this concept. The aim of our study is to determine the prevalence of multi-switchers with spondylarthritis, identify their characteristics, and analyse the number and reasons for switching in a Moroccan population. Patients and methods: This is a comparative cross-sectional study that included patients with SpA diagnosed according to the 2009 ASAS criteria admitted to our department for targeted treatment. Sociodemographic data, comorbidities, and clinical, paraclinical, and therapeutic characteristics were collected for each patient. Multi-switchers who had received at least two biologics were considered to be SpA DaT. Their prevalence was estimated, and a comparison was made with a control group of non-multi-switchers (SpA-non-DaT). Results: Two hundred and ten patients were included, 56.2% of whom were men, 63% with a long average disease duration. The prevalence of multi-switchers was 32.7%. Compared to the control group, patients in the DaT group were predominantly female (53.6% versus 39%, p=0.04), had more axial involvement (76.8% versus 91.5%, p=0.003) and peripheral joint involvement (88.4% versus 67.4%, p= 0.001) and associated fibromyalgia (33.3% versus 66.7%, p = 0.980), CsDMARD use (97.1% versus 31.9%, p= Conclusion: This study reveals a significant prevalence of patients with multiple treatment changes in the Moroccan population, highlighting the need for a larger patient sample to better define this condition.
VL  - 14
IS  - 4
ER  -

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Author Information

Séiny Kanta

Department Rheumatology, Mohammed V University Faculty of Medicine and Pharmacy, Rabat, Morocco

Contact Email

http://orcid.org/0009-0003-8370-6884
Najlae El Ouardi

Department Rheumatology, Mohammed V University Faculty of Medicine and Pharmacy, Rabat, Morocco

http://orcid.org/0000-0003-1228-391X
Mahamadou Sagara

Department Rheumatology, Mohammed V University Faculty of Medicine and Pharmacy, Rabat, Morocco

http://orcid.org/0009-0001-6527-5633
Hajar Zouaki

Department Rheumatology, Mohammed V University Faculty of Medicine and Pharmacy, Rabat, Morocco

http://orcid.org/0009-0000-5161-8271
Houda El Assad

Department Rheumatology, Mohammed V University Faculty of Medicine and Pharmacy, Rabat, Morocco

http://orcid.org/0009-0004-7362-5148
Alassane Alidou Garba

Department Rheumatology, Mohammed V University Faculty of Medicine and Pharmacy, Rabat, Morocco

http://orcid.org/0009-0006-1185-3676
El Kacem El Marbouh

Department Rheumatology, Mohammed V University Faculty of Medicine and Pharmacy, Rabat, Morocco

http://orcid.org/0009-0007-6163-273X
Laila Taoubane

Department Rheumatology, Mohammed V University Faculty of Medicine and Pharmacy, Rabat, Morocco

http://orcid.org/0000-0002-1336-0174
Abderrahim Majjad

Department Rheumatology, Mohammed V University Faculty of Medicine and Pharmacy, Rabat, Morocco

http://orcid.org/0000-0002-5216-1354
Hamza Toufik

Department Rheumatology, Mohammed V University Faculty of Medicine and Pharmacy, Rabat, Morocco

http://orcid.org/0000-0003-2062-8877
Ahmed Bezza

Department Rheumatology, Mohammed V University Faculty of Medicine and Pharmacy, Rabat, Morocco

http://orcid.org/0000-0003-3788-7146

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APA Style

Kanta, S., Ouardi, N. E., Sagara, M., Zouaki, H., Assad, H. E., et al. (2025). Difficult-to-treat Spondyloarthritis: What Are the Associated Factors. Science Journal of Clinical Medicine, 14(4), 95-100. https://doi.org/10.11648/j.sjcm.20251404.13

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ACS Style

Kanta, S.; Ouardi, N. E.; Sagara, M.; Zouaki, H.; Assad, H. E., et al. Difficult-to-treat Spondyloarthritis: What Are the Associated Factors. Sci. J. Clin. Med. 2025, 14(4), 95-100. doi: 10.11648/j.sjcm.20251404.13

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AMA Style

Kanta S, Ouardi NE, Sagara M, Zouaki H, Assad HE, et al. Difficult-to-treat Spondyloarthritis: What Are the Associated Factors. Sci J Clin Med. 2025;14(4):95-100. doi: 10.11648/j.sjcm.20251404.13

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@article{10.11648/j.sjcm.20251404.13,
  author = {Séiny Kanta and Najlae El Ouardi and Mahamadou Sagara and Hajar Zouaki and Houda El Assad and Alassane Alidou Garba and El Kacem El Marbouh and Laila Taoubane and Abderrahim Majjad and Hamza Toufik and Ahmed Bezza},
  title = {Difficult-to-treat Spondyloarthritis: What Are the Associated Factors},
  journal = {Science Journal of Clinical Medicine},
  volume = {14},
  number = {4},
  pages = {95-100},
  doi = {10.11648/j.sjcm.20251404.13},
  url = {https://doi.org/10.11648/j.sjcm.20251404.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjcm.20251404.13},
  abstract = {Introduction: There have been significant advances in the treatment of spondylarthritis (SpA) in recent years. Despite these advances, there is still a proportion of patients who experience multiple changes in biologic, which may correspond to difficult-to-treat spondylarthritis (SPA DaT). Unlike rheumatoid arthritis, there is no consensus definition for this concept. The aim of our study is to determine the prevalence of multi-switchers with spondylarthritis, identify their characteristics, and analyse the number and reasons for switching in a Moroccan population. Patients and methods: This is a comparative cross-sectional study that included patients with SpA diagnosed according to the 2009 ASAS criteria admitted to our department for targeted treatment. Sociodemographic data, comorbidities, and clinical, paraclinical, and therapeutic characteristics were collected for each patient. Multi-switchers who had received at least two biologics were considered to be SpA DaT. Their prevalence was estimated, and a comparison was made with a control group of non-multi-switchers (SpA-non-DaT). Results: Two hundred and ten patients were included, 56.2% of whom were men, 63% with a long average disease duration. The prevalence of multi-switchers was 32.7%. Compared to the control group, patients in the DaT group were predominantly female (53.6% versus 39%, p=0.04), had more axial involvement (76.8% versus 91.5%, p=0.003) and peripheral joint involvement (88.4% versus 67.4%, p= 0.001) and associated fibromyalgia (33.3% versus 66.7%, p = 0.980), CsDMARD use (97.1% versus 31.9%, p= Conclusion: This study reveals a significant prevalence of patients with multiple treatment changes in the Moroccan population, highlighting the need for a larger patient sample to better define this condition.},
 year = {2025}
}

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TY  - JOUR
T1  - Difficult-to-treat Spondyloarthritis: What Are the Associated Factors
AU  - Séiny Kanta
AU  - Najlae El Ouardi
AU  - Mahamadou Sagara
AU  - Hajar Zouaki
AU  - Houda El Assad
AU  - Alassane Alidou Garba
AU  - El Kacem El Marbouh
AU  - Laila Taoubane
AU  - Abderrahim Majjad
AU  - Hamza Toufik
AU  - Ahmed Bezza
Y1  - 2025/12/31
PY  - 2025
N1  - https://doi.org/10.11648/j.sjcm.20251404.13
DO  - 10.11648/j.sjcm.20251404.13
T2  - Science Journal of Clinical Medicine
JF  - Science Journal of Clinical Medicine
JO  - Science Journal of Clinical Medicine
SP  - 95
EP  - 100
PB  - Science Publishing Group
SN  - 2327-2732
UR  - https://doi.org/10.11648/j.sjcm.20251404.13
AB  - Introduction: There have been significant advances in the treatment of spondylarthritis (SpA) in recent years. Despite these advances, there is still a proportion of patients who experience multiple changes in biologic, which may correspond to difficult-to-treat spondylarthritis (SPA DaT). Unlike rheumatoid arthritis, there is no consensus definition for this concept. The aim of our study is to determine the prevalence of multi-switchers with spondylarthritis, identify their characteristics, and analyse the number and reasons for switching in a Moroccan population. Patients and methods: This is a comparative cross-sectional study that included patients with SpA diagnosed according to the 2009 ASAS criteria admitted to our department for targeted treatment. Sociodemographic data, comorbidities, and clinical, paraclinical, and therapeutic characteristics were collected for each patient. Multi-switchers who had received at least two biologics were considered to be SpA DaT. Their prevalence was estimated, and a comparison was made with a control group of non-multi-switchers (SpA-non-DaT). Results: Two hundred and ten patients were included, 56.2% of whom were men, 63% with a long average disease duration. The prevalence of multi-switchers was 32.7%. Compared to the control group, patients in the DaT group were predominantly female (53.6% versus 39%, p=0.04), had more axial involvement (76.8% versus 91.5%, p=0.003) and peripheral joint involvement (88.4% versus 67.4%, p= 0.001) and associated fibromyalgia (33.3% versus 66.7%, p = 0.980), CsDMARD use (97.1% versus 31.9%, p= Conclusion: This study reveals a significant prevalence of patients with multiple treatment changes in the Moroccan population, highlighting the need for a larger patient sample to better define this condition.
VL  - 14
IS  - 4
ER  -

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