Early diagnosis and spinal bone disease in axial spondyloarthritis

Abstract

Axial spondyloarthritis is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints, often beginning in early adulthood and leading to long-term structural damage and disability. Despite advances in disease recognition and management, patients continue to experience diagnostic delays, frequently spanning several years and resulting in missed opportunities for early intervention.

This thesis addresses two central challenges in axial spondyloarthritis: the feasibility of early diagnosis and the mechanisms underlying spinal bone disease. To this end, data from large international cohorts were used to investigate key questions, including how reliably the disease can be identified in its earliest stages, the clinical relevance of impaired spinal mobility, and the interplay between inflammation, bone loss, and new bone formation within the spine.

This work is the first to demonstrate that early diagnosis, within the first two years after symptom onset, is achievable when patients are referred promptly and evaluated by experienced specialists. By leveraging low-dose computed tomography and magnetic resonance imaging, this thesis provides novel insights into vertebral bone changes at an unprecedented level of detail. These findings inform early detection strategies and advance understanding of spinal bone disease, supporting more timely and targeted management for patients with axial spondyloarthritis.