Addressing psychological and lifestyle factors in addition to inflammation could help ensure effective management of axial spondyloarthritis (axSpA), according to a study published in Rheumatology. The researchers conducted a cross-sectional study of 332 patients with axSpA from the Groningen Leeuwarden axSpA cohort. Using structural equation modeling (SEM), the researchers investigated how biopsychosocial factors influenced disease activity as measured by the Axial Spondyloarthritis Disease Activity Score (ASDAS). Despite standard anti-inflammatory treatment, many patients reported persistently high ASDAS. Th e model included demographic, psychological, and lifestyle variables such as educational level, BMI, physical activity (mSQUASH), central sensitization, illness perception, pain catastrophizing, coping, anxiety, and depression; the fi nal SEM model showed that central sensitization, illness perception, and BMI had direct and significant associations with ASDAS. Psychological well-being and education were indirectly related to disease activity through their influence on illness perception