EditorialSpondyloarthritis: A window of opportunity?
Section snippets
SpA patterns
The window-of-opportunity concept requires a definition of “early-stage” disease. The timing of early-stage disease is difficult to determine. Nevertheless, identification of an early stage is clearly infeasible in ankylosing spondylitis (AS), as this disease is characterized by established radiographic sacroiliitis, which usually becomes detectable only several years after disease onset. Thus, the window of opportunity cannot be identified in AS. The window-of-opportunity concept can apply
Objectives
One of the main objectives of detecting the window of opportunity in nr-axSpA may be to prevent or to slow the development of structural damage, most notably the ossification process.
Inflammation is often viewed as the inciting cause of ossification [5], [6]. If this is the case, then, in theory, early control of the inflammatory process should prevent the development of ossifications. Recent magnetic resonance imaging (MRI) studies support this possibility. Thus, during TNFα antagonist
Conclusion
Several lines of evidence suggest that TNFα antagonists, and probably NSAIDs, exhibit greater clinical and biological efficacy when started early and produce structural benefits when used early and/or for prolonged periods. The chances of achieving a remission, and even of persistence of the remission without treatment, seem highest in recent-onset disease with axial MRI inflammation and/or CRP elevation. These criteria are associated with an increased risk of ossified structural lesions. Thus,
Disclosure of interest
Pascal Claudepierre has received honoraria for work as a consultant or interventions during symposia held by Pfizer, Abbvie, Roche-Chugai, MSD, Janssen, and UCB (less than 2000 € each time) and has been the chief investigator of therapeutic trials sponsored by Roche-Chugai, Sanofi Aventis, Abbvie, Pfizer, Janssen, MSD, BMS, and Celgène.
References (25)
- et al.
Ankylosing spondylitis, spondyloarthropathy, spondyloarthritis, or spondylarthritis: what's in a name?
Joint Bone Spine
(2012) - et al.
Non-radiographic spondyloarthritis: a theoretical concept or a real entity?
Joint Bone Spine
(2012) - et al.
New bone formation in axial spondyloarthritis
Joint Bone Spine
(2013) - et al.
Are inflammation and ossification on separate tracks in ankylosing spondylitis?
Joint Bone Spine
(2008) - et al.
Early diagnosis and management are crucial in spondyloarthritis
Joint Bone Spine
(2013) - et al.
What is the evidence for the presence of a therapeutic window of opportunity in rheumatoid arthritis? A systematic literature review
Ann Rheum Dis
(2013) - et al.
Timing the therapeutic window of opportunity in early rheumatoid arthritis: proposal for definitions of disease duration in clinical trials
Ann Rheum Dis
(2012) - et al.
Critical appraisal of assessment of structural damage in ankylosing spondylitis: implications for treatment outcomes
Arthritis Rheum
(2008) - et al.
Suppression of inflammation and effects on new bone formation in ankylosing spondylitis: evidence for a window of opportunity in disease modification
Ann Rheum Dis
(2013) - et al.
Which spinal lesions are associated with new bone formation in patients with ankylosing spondylitis treated with anti-TNF agents? A long-term observational study using MRI and conventional radiography
Ann Rheum Dis
(2013)