Difficult-to-Treat Disease in PsA and axSpA: Lessons from 2025, with Eric Ruderman, MD

As the therapeutic landscape in psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) continues to evolve, 2025 was less about splashy approvals and more about refining strategy in disease care. While prior years brought a steady stream of new mechanisms and pivotal trial readouts, the past year tended toward consolidation, with a focus on deepening understanding of existing agents, durability of response, and real-world treatment patterns. For clinicians, this recalibration reflects a maturing field grappling not only with efficacy benchmarks, but with long-term disease control, persistence on therapy, and the realities of heterogeneous patient populations.

Eric Ruderman, MD, Professor, Feinberg School of Medicine, Northwestern University, is giving year in review talks on both PsA and AxSpA at the 2026 Rheumatology Winter Clinical Symposium (RWCS) held in Maui, Hawaii, on February 11-14, examining the most meaningful developments in PsA and axSpA.

RheumatologyLive spoke with Ruderman during the meeting, during which he highlighted incremental but clinically relevant updates: new data on biologic continuation rates in axSpA, insights into why patients discontinue therapy, and emerging evidence around dose optimization strategies, including escalation approaches with established agents. He also touched on early signals from pipeline development, including a novel JAK1 inhibitor largely advancing outside the US market, underscoring the increasingly global nature of therapeutic innovation.

Perhaps most importantly, the progress seen in 2025 reinforced where the greatest unmet need lies. Across both PsA and axSpA, attention has increasingly turned toward patients with difficult to treat disease. Ruderman explored how this designation encompasses more than one clinical reality. Some patients have truly refractory inflammatory disease that may ultimately require new mechanisms or combination strategies. Others face overlapping comorbidities, structural damage, or non-inflammatory drivers of symptoms that complicate management despite adequate immunologic control. Distinguishing between these groups has become central to optimizing care.

“There are people who are difficult to treat or difficult to manage because they have other complications or other issues that get in the way of managing the disease, versus those who have just truly refractory inflammatory disease, which is a subset of those people, and they're very different groups of people,” Ruderman emphasized.

References

1. Ruderman E. Rheumatology 2025: Year in Review. What’s new in PsA. Presented at: RWCS 2026, February 11-14 in Maui, Hawaii.

2. Ruderman E. Rheumatology 2025: Year in Review. What’s new in Spondyloarthritis. Presented at: RWCS 2026, February 11-14 in Maui, Hawaii.