Do we need new therapies in spondyloarthritis?

<p>This episode of <em>RheumaCast</em> explores why many individuals with axial spondyloarthritis (axSpA) fail to achieve remission, despite access to advanced therapies. The discussion centers on two key factors often overlooked in daily practice: diagnostic inaccuracy and the presence of non-inflammatory pain mechanisms such as nociplastic and neuropathic pain.</p><p>While a small group of patients presents with true treatment-refractory axSpA—characterized by persistent inflammation despite multiple advanced therapies—most cases of apparent non-response are explained by symptoms not driven by inflammation. These require different management strategies, including psychological support, structured exercise, and targeted pharmacological approaches.</p><p>The episode also addresses emerging therapeutic concepts, including dual-targeted strategies, modulation of the HLA-B27 immunopeptidome, and novel immune targets. Making remission a reality for all patients will depend on both better use of existing treatments and the development of new ones.</p><p>This episode is based on the publication: Poddubnyy D, et al. <em>EULAR Rheumatol Open</em> 2025;1:484–487 and developed with NotebookLM.</p>