Turn on cookies to sign in
Signing in saves your progress to your Curie account. We can only do that with cookies on — turn them on to continue.
Even the best drugs for spondyloarthritis leave many patients with lingering symptoms — and it's not always because the medication isn't working. Experts say nociplastic pain, degenerative changes, and comorbidities like depression and obesity are often the real culprits behind residual disease. The takeaway: switching DMARDs isn't always the answer.
Even with a growing arsenal of biologics and DMARDs, many spondyloarthritis (SpA) patients continue to experience persistent symptoms after treatment — and experts say the problem is widely misunderstood. New phase II-III trial data for filgotinib (a JAK inhibitor) and vunakizumab (an anti-IL-17A antibody) showed meaningful improvements over placebo in axial SpA, but ASAS40 response rates still topped out around 40–55% — meaning a significant portion of patients don't achieve full relief even in successful trials.
The core issue? Residual symptoms often aren't driven by ongoing inflammation at all. Nociplastic pain, degenerative disc disease, and comorbidities like depression and obesity frequently contribute to lingering complaints — yet many physicians reflexively switch DMARDs when patients report them. Experts urge a more holistic approach: physical therapy, exercise, and targeted medications like gabapentin or SSRIs for non-inflammatory pain.
Key Takeaways
Why it matters: Misattributing non-inflammatory symptoms to active disease leads to unnecessary DMARD cycling — exposing patients to side effects and costs without benefit. Recognizing the true drivers of residual disease is critical to better, more personalized SpA care.
