title: Spondyloarthritis: state of the art and future perspectives.
abstract: Advances in the understanding of this group of arthritides over the past decade can be considered transformational from the perspective of basic mechanisms as well as clinical research focusing on the development of imaging technologies and a spectrum of standardised clinical outcomes that aim at a more comprehensive understanding of disease activity, functioning and disability, and prognosis. Prior to this decade, treatment was unsatisfactory and limited to physical modalities and non-steroidal anti-inflammatory agents, while diagnostic ascertainment primarily focused on clinical evaluation and plain radiography. Today, patients with spondyloarthritis (SpA) can look forward to earlier diagnosis and more effective treatment but significant challenges remain. This review will summarise the past decade's major accomplishments in the understanding of the basic mechanisms contributing to the development of SpA, outline those advances in clinical and imaging outcomes that have enabled major therapeutic advances and now permit a broader understanding of the early development of disease and its impact on patient well-being, and will describe new approaches to the development of diagnostic criteria that incorporate advances in imaging.
authors.affiliation: Department of Rheumatology, C1R, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. d.vanderheijde@kpnplanet.nl
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.forename: Walter P
authors.initials: WP
authors.lastname: Maksymowych
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D020022:Genetic Predisposition to Disease; D015796:HLA-B27 Antigen / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D012219:Rheumatology / Q000639:trends; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics* / Q000276:immunology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D015796:HLA-B27 Antigen; D014409:Tumor Necrosis Factor-alpha