Adherence to Biologics and Psycho-cognitive Factors in Axial Spondyloarthritis: A Multicentric Cross-sectional Study

Abstract

Background/Objective: Adherence to treatment in axial spondyloarthritis (axSpA) remains poorly documented, with estimates ranging from 28.2% to 70.6%. Psychological factors may influence adherence. This study aimed to assess adherence to biological disease-modifying antirheumatic drugs (bDMARDs) and evaluate the impact of catastrophizing, fibromyalgia, anxiety, and depression on adherence. Methods: We conducted a 1-year multicenter cross-sectional study, including consecutive axSpA patients fulfilling ASAS criteria. Participants completed a self-administered questionnaire covering demographic data, disease characteristics, and activity scores. Adherence was assessed using the Girerd scale (GS); psychological assessments included the Pain Catastrophizing Scale (PCS), Fibromyalgia Rapid Screening Tool (FIRST), and Hospital Anxiety and Depression Scale (HADS). Results: Among 500 patients, 49.2% showed good adherence (GS=0). Prevalence of catastrophizing, fibromyalgia, anxiety, and depression was 17.2%, 21.4%, 25.6%, and 11.0%, respectively. Good adherence was significantly associated with older age (mean 53.3 vs. 45.9 y; p <0.001), retirement status (26.4% vs. 12.6%; p <0.001), and lower educational level (OR: 1.84; 95% CI: 1.23-2.75; p =0.003). Poor adherence was linked to anxiety (OR: 1.53; 95% CI: 1.02-2.30; p =0.041) and catastrophizing (OR: 1.61; 95% CI: 1.00-2.58; P =0.049). In multivariate analysis, younger age (OR: 0.96; 95% CI: 0.95-0.98; p <0.001) and anxiety (OR 1.72; 95% CI: 1.05-2.81; p =0.031) remained significantly associated with poor adherence. Conclusions: About half of axSpA patients had suboptimal adherence to bDMARDs. Younger age, anxiety, and catastrophizing were associated with poor adherence and should be considered in patient management.