Spondyloarthritis Accelerating the patient journey from first symptoms to adequate treatment

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).