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Early detection of spondyloarthritis

Project Manager


Axial spondyloarthritis (SpA) is a rheumatic disease that is characterized by inflammation in the pelvic joints and back that causes back and pelvic pain. The disease affects approximately 1% of the population and begins in young adulthood, usually in the 20s and 30s. In the past, diagnosis was based on inflammatory changes shown on X-rays, but such changes developed slowly, and many patients previously received a clear diagnosis many years after the symptoms started. Later, MR examinations have shown to be able to detect inflammatory changes in the spine and pelvic joints much earlier. In 2009, new criteria were developed for axial SpA, the ASAS criteria, and these are based on both X-ray and MRI examinations in addition to typical SpA symptoms and blood tests. It was hoped that, with support in 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 find out whether patients with back pain of short duration can be diagnosed as early axial SpA with support in the ASAS criteria. Furthermore, one wants to look at which parameters best predict SpA diagnosis and how SpA can best be distinguished from other diagnoses. They also want to look at the development of disease over time and map the burden of disease for the patients and the socio-economic burden of disease.

The SPACE study is an international multicentre observational study where there are study centers in the following countries: The Netherlands, Italy, Sweden, Portugal and Norway. Diakonhjemmet Sykehus is the only Norwegian study centre.


Patients with chronic back pain lasting more than 3 months and less than 2 years as well as the 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 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 were included when the inclusion ended. Internationally, a total of around 700 patients have been included. Inclusion has been completed.


Patients who are 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, we have the patient answer a questionnaire, be examined thoroughly, check blood samples and take an X-ray and MRI examination.

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

Another study center is now also in the process of 10-year study visits of patients who before or at the 2-year study visit had a diagnosis of axial SpA. At the 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 autumn 2023. This study visit will include an examination by a physiotherapist, a doctor's appointment, blood tests as well as an MRI and X-ray of the back.