Spondyloarthritis caught early

project manager


phd fellow

About the project

Axial spondyloarthritis (SpA) is a rheumatic disease characterized by inflammation of the pelvic joints and spine that causes back and pelvic pain. The disease affects about 1% of the population and has an onset in young adulthood, usually in the 20-30s. In the past, diagnosis was based on inflammatory changes shown on X-rays, but such changes developed slowly and many patients used to receive a definite diagnosis many years after the onset of their symptoms. More recently, MRI scans have been shown to detect inflammatory changes in the spine and pelvic joints much earlier. In 2009, new criteria for axial SpA, the ASAS criteria, were developed and these are based on both X-ray and MRI examinations as well as typical SpA symptoms and blood tests. It was hoped that by using the ASAS criteria, it would be possible to determine earlier whether patients with back pain had axial SpA or not.

The purpose of the SPACE study is to determine whether patients with back pain of short duration can be diagnosed as early axial SpA using the ASAS criteria. Furthermore, we want to look at which parameters best predict SpA diagnosis and how SpA can best be distinguished from other diagnoses. We also want to look at the development of the disease over time and map the burden of disease for patients and socio-economic burden of disease.

The SPACE study is an international multicenter observational study with study centers in the following countries: The Netherlands, Italy, Sweden, Portugal and Norway. Diakonhjemmet Hospital is the only Norwegian study center.

Who can participate?

Patients with chronic back pain with a duration of more than 3 months and less than 2 years and onset of back pain before the age of 45 years were considered for further follow-up in the study at the first study visit (baseline). Patients with suspected/possible axial SpA with more than 1-2 well-defined SpA characteristics were offered further participation in the SPACE study.

Inclusion started in 2009 (in Norway in 2010) and was completed in 2016 (in Norway in 2014). In Norway, 100 patients have been included when the inclusion was finalized. Internationally, a total of about 700 patients have been included. Inclusion is finalized.

Project arrangement

Patients followed up regularly for 2 years with study visits after 3 months, after 1 year and after 2 years. At these study visits, patients answered questionnaires, underwent a thorough examination, had blood tests, and had X-rays and MRI scans.

At other study centers in other countries, patients with diagnosed axial SpA are followed up after 2 years with study visits every other year, but in Norway we have not participated in this part of the study.  

Other study centers are now also conducting 10-year study visits of patients who before or at the 2 year study visit had a diagnosis of axial SpA. At Diakonhjemmet we will participate in this part of the study. We plan to invite patients already included in the SPACE study with a diagnosis of axial SpA to a 10-year study visit, probably in the fall of 2023. This study visit will include an examination by a physiotherapist, a doctor's appointment, blood tests and MRI and X-rays of the spine.


All rights reserved © REMEDY; Illustration/portrait images © Nicolas Tourrenc/Diakonhjemmet Hospital