Spondyloarthritis is an umbrella term describing a family of chronic inflammatory diseases, that primarily affect the spine, sacroiliac and peripheral joints. The two most common members of this family are psoriasis-associated psoriatic arthritis and ankylosing spondylitis. Spondyloarthritis is characterized by articular manifestations (involving the peripheral and axial skeleton, enthesitis, and dactylitis) and extra-articular (skin, gut and eye) manifestations.

In total, spondyloarthritis affects around 0.5–2% of the population and significantly impacts the quality of life. For ankylosing spondylitis, individuals with the gene HLA-B27 are more likely to develop ankylosing spondylitis, and men are also more likely to develop ankylosing spondylitis than women. There is no cure for spondyloarthritis, but several treatment options can ease symptoms, inhibit inflammation and slow disease progression.

The current diagnosis includes a physical examination, blood tests and medical history. Here, imaging techniques such as X-ray of the sacroiliac joints and a part of the pelvis are used for initial analysis, and if available a magnetic resonance image (MRI) may also be used to diagnose spondyloarthritis. Together with the imaging techniques, an HLA tissue typing is performed to detect whether HLA-B27 and c-reactive protein (CRP) are present to measure the total level of inflammation.

There is a tremendous medical need for biomarkers in spondyloarthritis. The diagnosis is often delayed 5-10 years due to lower back and buttock pain. Thus, earlier diagnosis may provide patients access to effective therapies and a better remission. Biomarkers that could be used for diagnosis and monitoring of treatment response could improve patients' lives and reduce clinical trial size and length when developing new efficacious treatments.

Spondyloarthritis is characterized by chronic inflammation and tissue destruction in the joints and involved several tissues. These tissues include bone, cartilage and soft tissue, which all consist of different types of extracellular matrix (ECM) proteins – especially collagens. The extracellular matrix proteins are remodeled as a part of the normal homeostasis of the joint, where they are broken down and rebuilt as part of the normal repair and maintenance of the tissue. In spondyloarthritis, this balance between degradation and formation of tissue is interrupted resulting in net degradation of the tissue. Protein fingerprint biomarkers can quantify this tissue turnover directly in a serum sample and serve as a liquid biopsy.

Visit our rheumatology biomarker portfolio and choose a panel that fits your clinical research or drug development targets!

Spondyloarthritis diseases involve several tissues and combining biomarkers measuring the tissue involved may provide information on disease pathology – we call this tissue profiling. Tissue profiling may aid the need for molecular subtyping - endotyping - patients and based on their profile choose the best treatment for the given patient. This may also be applied to clinical trials and the development of novel drugs. The Protein Fingerprint biomarkers can quantify the tissue profile in serum.

Biomarkers for spondyloarthritis:
Hypertrophicchrondrocytes:PRO-C2, C10C
Bone erosions:
Synovitis: CRPM, VICM, C3M, C4M, C6M
Degradation of cartilage:C2M, CTX-II, ARGS

Specific Protein Fingerprint biomarkers measuring endochondral bone formation, quantified by type II collagen formation (PRO-C2) and type X collagen degraded by cathepsins (C10C), could distinguish healthy individuals from axial spondyloarthritis and psoriatic arthritis patients.

Biomarkers measuring specific fragments of type I collagen (C1M), type II collagen (C2M), type III collagen (C3M) and type IV collagen (C4M), can distinguish ankylosing spondylitis patients from nrAxSpA and healthy matched controls. This information can be used to separate patients with/without axial involvement.

Patients with ankylosing spondylitis may be treated with a TNF-a inhibitory therapy. The biomarker measuring a metabolite of type I collagen degradation (C1M), is together with high sensitive C-reactive protein (hsCRP) lowered in patients treated with TNF-a inhibitory therapy. This reflects a decrease of connective tissue degradation and a lowered inflammation with treatment.

Our laboratory services offer customized solutions for your spondyloarthritis biomarker needs.

Spondyloarthritis involves the remodeling of three different types of tissues:

  • Connective tissue (fibrosis)
  • Bone resorption and cartilage turnover (ankylosis)
  • Flares, chronic and tissue inflammation (inflammation)

The involvement of the different tissues and pathways are associated with different level of disease activity and different stages of the disease. Hence patients with spondyloarthritis may be described by different molecular profiles (endotypes), which Protein Fingerprint biomarkers may reflect. This has previously been done in rheumatoid arthritis and osteoarthritis, where you clearly see come cluster with a more prone bone and/or inflammation phenotype than others. This may be applied to spondyloarthritis and used to endotype patients, based on their tissue profile.

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