The virtues of early diagnosis a window of opportunity in spondyloarthritis

17 August 2018
Spondyloarthritis is one of the most common types of chronic joint inflammation. Currently, most patients suffering from the illness need lifelong treatment. But recent studies by the VIB-UGent Center for Inflammation Research suggest that when diagnosed and treated early, disease progression may be halted to a point where patients no longer need medication nor suffer symptoms. The results are published in leading academic journal Arthritis and Rheumatology.

Accumulation of symptoms and increased risks
Associated with the VIB-UGent Center for Inflammation Research, Prof. Dirk Elewaut, clinical rheumatologist Filip Van den Bosch and PhD student Gaëlle Varkas studied over 1,000 patients suffering from axial spondyloarthritis, a typical form of the disease which affects the spine. Their research indicates that, in addition to rheumatological hallmarks of the condition such as inflammatory lower back pain, breathing problems and chest tightness, patients tend to develop other types of inflammation as well.

Prof. Dirk Elewaut (VIB-UGent Center for Inflammation Research): “We found that as the illness progresses, the risk increases for developing inflammatory bowel diseases and inflammation of the eye’s anterior chamber. This increased risk also appears to be linked to persistently elevated signs of inflammation in the blood. All this highlights the need for early diagnosis and treatment of spondyloarthritis to suppress symptoms and possibly also to prevent additional inflammatory illnesses.”

Window of opportunity
Another study – Clinical Remission in patients with Early peripheral SPondyloArthritis (CRESPA) – proves that early treatment of spondyloarthritis pays off. In this project, clinical rheumatologist Philippe Carron, Prof. Dirk Elewaut and clinical rheumatologist Filip Van den Bosch (all scientists at the VIB-UGent Center for Inflammation Research) looked at peripheral spondyloarthritis. This type of spondyloarthritis is predominantly characterized by inflammation of peripheral joints and tendons (for example in hips, knees or ankles). 

Clinical rheumatologist Philippe Carron (VIB-UGent Center for Inflammation Research): “We gathered 60 people who had been suffering from the disease for fewer than 12 weeks and treated them intensively. After symptoms had gone away, we stopped medication altogether. Our team then kept track of the patients to see whether symptoms reappeared.

“It became clear that we had found a window of opportunity: a short timeframe in the early stages of the disease during which the illness is more susceptible to treatment, yielding better outcomes. In fact, we saw that more than half of patients remained symptom-free even after treatment had ended. These patients no longer needed any medication and didn’t relapse. It’s the first time that we achieved such a success, and we strongly believe that this is partly because these patients only suffered from the disease for such a short amount of time.”

From peripheral to axial
The next step is to test whether this window of opportunity also exists for the axial type of spondyloarthritis, Bechterew’s Disease. That’s the idea behind a new research project – the Go-Gut study – which aims to treat patients early in their disease process, who have suffered axial symptoms for fewer than 12 months.

Prof. Dirk Elewaut (VIB-UGent Center for Inflammation Research): “By treating patients early and then phasing out medication, we hope to see the same positive effects as in the CRESPA study. Confirming the window of opportunity in patients with inflammation of the spine would underscore the need for diagnosing spondyloarthritis early even more. This is especially important as in this axial form of spondyloarthritis it can take up to several years before the diagnosis is being made.”


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