Elsevier

Joint Bone Spine

Volume 81, Issue 3, May 2014, Pages 197-199
Joint Bone Spine

Editorial
Spondyloarthritis: A window of opportunity?

https://doi.org/10.1016/j.jbspin.2014.02.008Get rights and content

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.

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