Spondyloarthritis (SpA) is a group of rheumatic diseases characterized by inflammation of the spine and the sacroiliac (SI) joints. This often results in pain and / or stiffness of the (lower) spine and/or neck. Ankylosing spondylitis (AS) is the most representative type of SpA and is defined by the presence of inflammation at the sacroiliac joints (sacroiliitis) visible on radiographs. In some patients the inflammation also affects the spine and eventually may result in complete ossification of the spine. It is possible that sacroiliitis there is no sacroiliitis by imaging or only visible on MRI. Inflammation may affect other regions such as peripheral joints (e.g. knees and ankles), tendons (e.g. Achilles tendon), eyes, skin, and/or gut. Depending on the location of the complaints, patients can be divided into axial and/or peripheral SpA. In axial SpA, back pain is the most common symptom, while in peripheral SpA inflammation of peripheral joints and tendons are the most common features.
Accurate data on the occurrence (prevalence) of SpA in the Netherlands are missing, as well as figures on the ratio between axial and peripheral SpA. SpA usually occurs before the age of 45, the symptoms often start between the 20th and 30th year. It was long thought that AS is a disease of young adult men. However, the disorder is also common in women, although they often have a less severe course of the disease and therefore SpA is not always recognized. Recent information shows that the prevalence in women is as high as in men.
SpA is currently treated with non-steroid anti-inflammatory drugs (NSAIDs) and exercise therapy. In addition, new effective drugs (TNFα-blockers drugs) have recently been introduced, which can control the symptoms in some patients who do not respond to conventional drugs.
Unfortunately, the cause of inflammation in SpA is not yet clear. However, there is an association between SpA and the genetic factor HLA-B27. But there are still many questions about SpA. A large international network interested in research about SpA is the Assessment of SpondyloArthritis International Society (ASAS), started by Prof. van der Heijde.
By using patient data, we are trying to find answers to a lot of unsolved questions involving SpA. The data is collected in studies. Currently there are two descriptive (observational) studies at the rheumatology outpatient clinic of the LUMC:
Besides these two observational studies, there are also several studies in the rheumatology department on the effects of medications (trials).
Medication research (trials)
Although new drugs such as anti-TNFα have been developed, there are still some patients who do not respond to any drug. Moreover, these therapies are currently indicated in patients with AS, that means when radiographic damage is already present. New studies (trials) investigate the efficacy of new drugs and also the efficacy in early stage of the disease.
In the rheumatology outpatient clinic of the LUMC we participate in several international trials. The rheumatologist will determine whether a patient is eligible to participate in a trial.
Project management: Prof.Dr. D.M.F.M. van der Heijde
Contact person: Dr. F.A. van Gaalen