- Author
-
H.M.Y. de Jong
- Title
- Spondyloarthritis
- Subtitle
- Accelerating the patient journey from first symptoms to adequate treatment
- Supervisors
- Co-supervisors
-
M.G.H. van de Sande
- Award date
- 6 March 2020
- Number of pages
- 160
- ISBN
- 9789463757515
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
The global aim of this thesis was to accelerate the patient journey from first symptoms to adequate treatment in spondyloarthritis (SpA) by a) tailoring the diagnostic process in order to enable an earlier diagnosis and b) tailoring the treatment strategy to shorten the time from diagnosis to remission and to increase remission rates in patients with SpA. To investigate which markers could aid in making an earlier diagnosis, we investigated which clinical features characterize females with SpA (chapter 2) and which clinical and imaging features are specifically present in individuals with an increased risk of developing SpA (chapter 3). Very early (pre-clinical) aggressive treatment as well as add-on treatment targeting low residual disease activity could induce remission in higher number of patients. To investigate tailored treatment strategies, we investigated the willingness of individuals at risk to develop SpA to use preventive treatment, if this would become available (chapter 4), if initial treatment with TNFα inhibitors induces higher remission rates in patients with early disease (chapter 5), if remission is sustained after discontinuing TNFα inhibitors which were started as initial treatment (chapter 6), and the safety and efficacy of an non-drug add-on treatment for patients with residual disease activity (chapter 7).
- Persistent Identifier
- https://hdl.handle.net/11245.1/67aa6289-6cd3-4fe6-92de-603c4c4dbda6
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and outline
Chapter 2: Differences between females and males in axial spondyloarthritis: data from a real-life cross-sectional cohort
Chapter 3: HLA-B27 is associated with progression from subclinical inflammation to overt spondyloarthritis rather than the presence of subclinical inflammation per se in seemingly healthy first degree relatives of spondyloarthritis patients: data from the Pre-SpA cohort
Chapter 4: First-degree relatives of axial spondyloarthritis patients of the Pre-SpA cohort would consider using medication in a preventive setting
Chapter 5: Achieving remission in psoriatic arthritis by early initiation of TNF inhibition: a double-blind, randomised, placebo-controlled trial of golimumab plus methotrexate versus placebo plus methotrexate
Chapter 6: Sustained remission with methotrexate monotherapy after 22 weeks induction treatment with TNF-alpha inhibitor and methotrexate in early psoriatic arthritis: an open label extension of a randomized placebo-controlled trial
Chapter 7: An add-on training program involving breathing exercises, cold exposure, and meditation attenuates inflammation and disease activity in axial spondyloarthritis: a proof of concept trial
Chapter 8: General discussion and summary
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