This thesis showed that there appears much room for improvement in optimizing physical activity and exercise of people with axial spondyloarthritis (axSpA), both in patients using and not using... Show moreThis thesis showed that there appears much room for improvement in optimizing physical activity and exercise of people with axial spondyloarthritis (axSpA), both in patients using and not using individual physical therapy and axSpA-specific group exercise. Although recommended, only a minority engages in high-intensity aerobic physical activity and in strengthening and mobility exercise with the recommended frequency. This is also the case in people with axSpA using physical therapy. Furthermore, certain evidence-based enhancements in axSpA-specific exercise groups seem warranted. A pilot implementation of these enhancements was found to be partially successful and a number of barriers remain to be overcome in a larger-scale implementation. Because only a small minority of people with axSpA participate in such exercise groups, it is also desired to implement modifications to individual physical therapy as well as interventions in which people with axSpA can participate independently (without supervision). A number of components of such interventions were identified in this thesis. Show less
The first section of this thesis aims to provide an international perspective on the characterisation of patients with axial spondyloarthritis. Through different aspects of the classification... Show moreThe first section of this thesis aims to provide an international perspective on the characterisation of patients with axial spondyloarthritis. Through different aspects of the classification criteria, we review the importance of global applicability of these criteria. As classification criteria ensure the same patients are selected for participation in clinical trials worldwide, global applicability would allow for direct comparisons between studies executed in different geographical regions. Likewise, standardised assessment and reporting of results from clinical trials allows for direct comparisons between studies investigating different treatments, or identical treatments in populations from a different ethnicity or background, which is debated in the second part of this thesis. Herein, we describe the process of the development of the core set for axial spondyloarthritis, specifically by updating the domains of the ASAS-OMERACT core set for ankylosing spondylitis. In the final part of this thesis, we discuss health-related quality of life and work and activity impairments in patients with chronic back pain suspected of axial spondyloarthritis. Show less
In this thesis we have pursued innovative analytical solutions for some of the most challenging questions in the field of SpA. We have gained better insights into the concept of axSpA by studying... Show moreIn this thesis we have pursued innovative analytical solutions for some of the most challenging questions in the field of SpA. We have gained better insights into the concept of axSpA by studying it independently of the rheumatologist’s opinion. Our findings likely add knowledge to what axSpA really is. Future studies will learn us how much of these insights will translate into a better recognition of the disease in clinical practice and in better classifying them for research purposes. Since SpA is a slowly progressing disease, several years are needed to see meaningful changes in imaging abnormalities of the axial skeleton, which poses methodological challenges. We have shown that thoughtful analytical approaches, that make best use of imaging data, are helpful in better estimating progression, in unravelling its determinants and in clarify which outcomes are best to monitor disease. Efforts are made to further improve outcome measurement in axSpA, including the development of new imaging techniques, which can benefit from our proposed solutions to long-term imaging scoring. Show less
In this thesis we aimed to investigate the burden of axial spondyloarthritis (axSpA) in an early phase. We have emphasized three main themes: (1) the value of a positive family history of SpA; (2)... Show moreIn this thesis we aimed to investigate the burden of axial spondyloarthritis (axSpA) in an early phase. We have emphasized three main themes: (1) the value of a positive family history of SpA; (2) the impact of axSpA on health outcomes in an early phase of axSpA; and (3) illness perceptions and coping strategies of patients with axSpA.We have shown that when broad HLA-B27 testing is not useful, the presence of a positive family history of axSpA or uveitis could be used to predict HLA-B27 positivity in patients suspected of axSpA. We have demonstrated that health-related quality of life work productivity, and daily activities are seriously impacted even in the earliest phase of the axSpA and remain substantial over time. We have further shown that illness perceptions are important in the relationship between back pain and health outcomes in patients with axSpA. Our results suggest that illness perceptions and coping strategies do not change spontaneously and are rather independent of a decrease in disease status in patients with early axSpA.The knowledge and insights of this thesis could help us in making a timely diagnosis, providing treatment sooner, and exploring additional treatment options, which in turn could hopefully reduce the burden of axSpA. Show less
In this thesis the focus was on diagnosing axSpA early using clinical features as well as imaging modalities. We have studied multiple elements diagnosing axSpA among patients presenting with... Show moreIn this thesis the focus was on diagnosing axSpA early using clinical features as well as imaging modalities. We have studied multiple elements diagnosing axSpA among patients presenting with chronic back pain. We have emphasized two main themes: (1) the importance of clinical SpA features; and (2) the contribution of imaging to an axSpA diagnosis and classification. We have learned how rheumatologists use imaging results in their diagnostic considerations and thereby have helped reduce certain fears regarding the way diagnosis is made in clinical practice. We have shown that the use of MRI-spine in classification is not efficient. The common thread in all of the studies in this thesis is that axSpA diagnosis is the interaction between the clinical aspects of chronic back pain and imaging findings highly suggestive of axSpA. Clinicians should be aware of mindlessly ‘stacking up’ SpA features in chronic back pain patients in order to avoid unnecessary (biologic) treatment. Additional studies are needed to investigate the numerous phenotypes of axSpA and to predict in which chronic back pain patient axSpA diagnosis is likely. Show less
The studies described in this thesis were all centred around the same aim: the early recognitionof axial spondyloarthritis (axSpA) and a minimization of the diagnostic delay. An importantstep in... Show moreThe studies described in this thesis were all centred around the same aim: the early recognitionof axial spondyloarthritis (axSpA) and a minimization of the diagnostic delay. An importantstep in tackling these issues was that experts in the field have designed prospective cohortstudies in which consecutive patients with either chronic or inflammatory back pain (thelatter being the most common first symptom) of short duration are included and followed upin a standardized manner with imaging performed at certain pre-set times. This allows us toobtain information on who will develop axSpA and who will not. Those cohort studies providevaluable information on the early detection and disease course of axSpA and form the basisof the research presented in this thesis. Show less
