Kreuzschmerzen aus rheumatologischer Sicht

Kreuzschmerzen sind das führende Symptom einer Gruppe entzündlich-rheumatischer Erkrankungen, die unter dem Überbegriff „Spondyloarthritiden“ zusammengefasst werden. Der vorliegende Beitrag diskutiert die wesentlichen klinischen, labormedizinischen und bildgebenden Merkmale der Spondyloarthritiden im differenzialdiagnostischen Kontext der Kreuzschmerzen und beleuchtet die aktuellen Therapieprinzipien der axialen Spondyloarthritis.

Abstract

Low back pain is the leading symptom of a family of inflammatory rheumatic diseases grouped under the umbrella term „spondyloarthritides“. This paper discusses the main clinical, laboratory, and imaging features of spondyloarthritides in the diagnostic context of low back pain. It also highlights the current therapeutic principles of axial spondyloarthritis.

Schlüsselwörter

Kreuzschmerzen - Rückenschmerzen - axiale Spondyloarthritis - ankylosierende Spondylitis - Morbus Bechterew

Key words

low back pain - axial spondyloarthritis - ankylosing spondylitis - diagnosis - therapy

Publikationsverlauf

Artikel online veröffentlicht:
28. März 2022

• Literatur

• 1 Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet 2017; 390: 73-84
• 2 Rudwaleit M, van der Heijde D, Landewe R. et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68: 777-783
• 3 Rudwaleit M, van der Heijde D, Landewe R. et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70: 25-31
• 4 Poddubnyy D. Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis. Rheumatology (Oxford) 2020; 59: iv6-iv17
• 5 Schmidt CO, Gunther KP, Goronzy J. et al. [Frequencies of musculoskeletal symptoms and disorders in the population-based German National Cohort (GNC)]. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 2020; 63: 415-425
• 6 Redeker I, Callhoff J, Hoffmann F. et al. Determinants of diagnostic delay in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Rheumatology (Oxford) 2019; 58: 1634-1638
• 7 Garrido-Cumbrera M, Navarro-Compan V, Bundy CI. et al. dentifying Parameters Associated with Delayed Diagnosis in Axial Spondyloarthritis: Data from the European Map of Axial Spondyloarthritis. Rheumatology (Oxford) 2021;
• 8 Poddubnyy D, Callhoff J, Spiller I. et al. Diagnostic accuracy of inflammatory back pain for axial spondyloarthritis in rheumatological care. RMD open 2018; 4: e000825
• 9 Hermann J, Giessauf H, Schaffler G. et al. Early spondyloarthritis: usefulness of clinical screening. Rheumatology (Oxford) 2009; 48: 812-816
• 10 Rudwaleit M, Khan MA, Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria?. Arthritis Rheum 2005; 52: 1000-1008
• 11 Proft F, Spiller L, Redeker I. et al. Comparison of an online self-referral tool with a physician-based referral strategy for early recognition of patients with a high probability of axial spa. Semin Arthritis Rheum 2020; 50: 1015-1021
• 12 Diekhoff T, Eshed I, Radny F. et al. Choose wisely: imaging for diagnosis of axial spondyloarthritis. Ann Rheum Dis 2021;
• 13 Weber U, Jurik AG, Zejden A. et al. Frequency and Anatomic Distribution of Magnetic Resonance Imaging Features in the Sacroiliac Joints of Young Athletes: Exploring “Background Noise” Toward a Data-Driven Definition of Sacroiliitis in Early Spondyloarthritis. Arthritis Rheumatol 2018; 70: 736-745
• 14 de Winter J, de Hooge M, van de Sande M. et al. Magnetic Resonance Imaging of the Sacroiliac Joints Indicating Sacroiliitis According to the Assessment of SpondyloArthritis international Society Definition in Healthy Individuals, Runners, and Women With Postpartum Back Pain. Arthritis Rheumatol 2018; 70: 1042-1048
• 15 Poddubnyy D, Weineck H, Diekhoff T. et al. Clinical and imaging characteristics of osteitis condensans ilii as compared with axial spondyloarthritis. Rheumatology (Oxford) 2020;
• 16 Diekhoff T, Greese J, Sieper J. et al. Improved detection of erosions in the sacroiliac joints on MRI with volumetric interpolated breath-hold examination (VIBE): results from the SIMACT study. Ann Rheum Dis 2018; 77: 1585-1589
• 17 Kiltz U, Braun J, Becker A. et al. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew’s disease and early forms, Update 2019: Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2019; 78: 3-64
• 18 van der Heijde D, Ramiro S, Landewe R. et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017; 76: 978-991
• 19 Smolen JS, Schols M, Braun J. et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis 2018; 77: 3-17
• 20 Poddubnyy D, Sieper J. Mechanism of New Bone Formation in Axial Spondyloarthritis. Curr Rheumatol Rep 2017; 19: 55