Page 135 - Recognizing axial spondyloarthritis - Janneke de Winter

INTRODUCTION
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease affecting the spine, peripheral joints and extra-articular sites. Early treatment of axSpA is important, since a delayed start of treatment is linked to worse clinical outcome (1,2).
In rheumatoid arthritis (RA) improving outcome was gained by early and aggressive treatment, which is nowadays standard of care (3). Moreover, attempts have been made (4) and trials are ongoing initiating treatment in the pre-clinical phase before the onset of clinical manifestations (5,6) aimed at preventing RA. In axSpA little is known about the possibilities, effects and desirability of early treatment, merely because of the difficult diagnostic process. Initiatives as the pre-SpA cohort (7), a prospective cohort of healthy first degree relatives of axSpA patients, and the SPACE (SPondyloArthritis Caught Early) cohort (8) might enable in a very early phase to identify, treat and thereby possibly even prevent axSpA. Therefore, also in axSpA, preventive treatment is an imaginable scenario.
To our knowledge, the willingness of first-degree relatives of axSpA patients to start preventive therapy has never been explored. If we know whether and under what circumstances at-risk individuals are willing to start preventive therapy, development of preventive treatment strategies could be targeted to that purpose.
The aim of this study was to investigate the willingness of individuals at increased risk of developing axSpA to initiate preventive treatment and evaluate which factors influence this decision.
METHODS
Study population
For this study all participants from the Pre-spondyloarthritis (Pre-SpA) cohort, known to have an increased risk to develop SpA, were approached regardless of their time of follow-up. This cohort has been described in detail previously (7). In short, Pre-SpA is an ongoing, prospective, multicenter inception cohort of healthy, first-degree relatives of HLA-B27-positive axSpA patients between 18-40 years of age. All were 1) not diagnosed as having SpA at the time of the baseline visit and 2) not treated for back pain by a physician. All participants gave their written informed consent and the ethics board of the Academic Medical Center Amsterdam approved the study protocol (Nl41248.018.12).
Survey
Participants completed a paper survey designed to assess their willingness to use treatment to prevent or delay the onset of SpA. The survey comprised six scenarios. In each scenario we changed one variable: 1) the likelihood of developing SpA varying from 30-70%, 2) the effectiveness of treatment; either complete prevention or 10 year delay of onset of SpA, 3) potential side effects, varying from none to
PREVENTIVE MEDICATION IN AXIAL SPA
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