SPACE
Early detection of spondyloarthritis
Project Manager
ABOUT THE PROJECT
Axial spondyloarthritis (SpA) is a rheumatic disease characterized by inflammation of the hip joints and back, which causes back and pelvic pain. The disease affects approximately 1% of the population and begins in young adulthood, usually in the 20s and 30s. Previously, diagnostics were based on inflammatory changes shown on X-rays, but such changes developed slowly, and many patients were previously diagnosed many years after the symptoms began. Later, MRI examinations have been shown to be able 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-rays and MRI examinations in addition to typical SpA symptoms and blood tests. It was hoped that by supporting the ASAS criteria, it would be possible to clarify earlier whether patients with back pain had axial SpA or not.
The purpose of the SPACE study is to determine whether patients with short-term back pain 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 the patients and the socioeconomic burden of the 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 JOIN?
Patients with chronic back pain lasting more than 3 months and less than 2 years and onset of back pain before the age of 45 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 features 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 had been included when inclusion was completed. Internationally, a total of approximately 700 patients have been included. Inclusion has been completed.
WHAT DOES THE STUDY INVOLVE?
Patients who were followed up were followed regularly for 2 years with study visits after 3 months, after 1 year and after 2 years. At these study visits, the patient answered a questionnaire, underwent a thorough examination, checked blood samples and had an X-ray and MRI examination.
At other study centers in other countries, patients with diagnosed axial SpA after 2 years are followed up with study visits every two years, but in Norway we have not participated in this part of the study.
At other study centers, a 10-year study visit is also underway for patients who were diagnosed with axial SpA before or at the 2-year study visit. 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 an MRI and X-ray of the back.