PDF herunterladen
Arthritis und Rheuma 2023; 43(05): 307-314
DOI: 10.1055/a-2154-0476
Schwerpunkt

Aktuelle Leitlinien der axialen Spondyloarthritis für Praxis und Klinik

Iuliia Kononenko
1   Ruhr-Universität Bochum und Rheumazentrum Ruhrgebiet, Herne
,
David Kiefer
1   Ruhr-Universität Bochum und Rheumazentrum Ruhrgebiet, Herne
,
Xenofon Baraliakos
1   Ruhr-Universität Bochum und Rheumazentrum Ruhrgebiet, Herne
,
Uta Kiltz
1   Ruhr-Universität Bochum und Rheumazentrum Ruhrgebiet, Herne
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

ZUSAMMENFASSUNG

Die axiale Spondyloarthritis (axSpA) ist eine entzündlich-rheumatische Erkrankung des Achsenskeletts, die vor allem durch chronische Rückenschmerzen gekennzeichnet ist. Im Verlauf der Erkrankung kann es zu Knochenneubildungen am Achsenskelett kommen. Internationale und nationale Leitlinien zielen darauf ab, die Diagnose einer axSpA kurz nach Symptombeginn zu stellen und eine effektive Therapie einzuleiten. Bei der Diagnosestellung spielt insbesondere die Bildgebung eine wichtige Rolle. Während das Röntgen und die Computertomografie (CT) strukturelle Läsionen gut darstellen können, ermöglicht die Magnetresonanztomografie (MRT) die Darstellung von entzündlichen und strukturellen Veränderungen. Die Behandlung von Patienten mit axSpA zeichnet sich durch eine Kombination aus nichtpharmakologischen und pharmakologischen Maßnahmen aus. Neben regelmäßiger körperlicher Aktivität können unterschiedliche Medikamentenklassen wie nichtsteroidale Antirheumatika (NSAR) und Biologika (biologic Disease-Modifying Antirheumatic Drugs, bDMARD) sowie targeted-synthetic DMARD (tsDMARD) verordnet werden. Im Laufe der Erkrankung können invasive Maßnahmen wie Injektionen oder Operationen in Frage kommen.

Schlüsselwörter

Axiale Spondyloarthritis - Bildgebung - MRT - Therapie


Publikationsverlauf

Artikel online veröffentlicht:
18. Oktober 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Kiltz U, Braun J. DGRh, et al Langfassung zur S3-Leitlinie Axiale Spondyloarthritis inklusive Morbus Bechterew und Frühformen, Update 2019: Evidenzbasierte Leitlinie der Deutschen Gesellschaft für Rheumatologie (DGRh) und der beteiligten medizinisch-wissenschaftlichen Fachgesellschaften und weiterer Organisationen [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 DOI: 10.1007/s00393-019-0670-3.
    CrossrefPubMedGoogle Scholar
  • 2 Ramiro S, Nikiphorou E, Sepriano A. et al ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023; 82: 19-34 DOI: 10.1136/ard-2022-223296.
    CrossrefPubMedGoogle Scholar
  • 3 Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet 2017; 390: 73-84 DOI: 10.1016/S0140-6736(16)31591-4.
    CrossrefPubMedGoogle Scholar
  • 4 Regierer AC, Weiß A, Baraliakos X. et al [RABBIT-SpA: a new disease register for axial spondyloarthritis and psoriatic arthritis]. Z Rheumatol 2020; 79: 135-142 DOI: 10.1007/s00393-019-0613-z.
    CrossrefPubMedGoogle Scholar
  • 5 Zhao SS, Pittam B, Harrison NL. et al Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatology 2023; 60: 1620-1628 DOI: 10.1093/rheumatology/keaa807.
    CrossrefPubMedGoogle Scholar
  • 6 Benavent D, Capelusnik D, Ramiro S. et al Looking through the window of opportunity in axial spondyloarthritis?. Jt bone spine 2023; 90: 105603 DOI: 10.1016/j.jbspin.2023.105603.
    CrossrefPubMedGoogle Scholar
  • 7 de Winter JJ, van Mens LJ, van der Heijde D. et al Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis. Arthritis Res Ther 2016; 18: 196 DOI: 10.1186/s13075-016-1093-z.
    CrossrefPubMedGoogle Scholar
  • 8 López-Medina C, Molto A, Sieper J. et al Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study. RMD Open 2021; 07: e001450 DOI: 10.1136/rmdopen-2020-001450.
    CrossrefPubMedGoogle Scholar
  • 9 Stolwijk C, van Tubergen A, Castillo-Ortiz JD. et al Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Rheum Dis 2015; 74: 65-73 DOI: 10.1136/annrheumdis-2013-203582.
    CrossrefPubMedGoogle Scholar
  • 10 Rudwaleit M, Haibel H, Baraliakos X. et al The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum 2009; 60: 717-727 DOI: 10.1002/art.24483.
    CrossrefPubMedGoogle Scholar
  • 11 Mielants H, Veys EM, Cuvelier C. et al The evolution of spondyloarthropathies in relation to gut histology. III. Relation between gut and joint. J Rheumatol 1995; 22: 2279-2284
    Google Scholar
  • 12 Karmacharya P, Crowson CS, Poudel D. et al Comorbidity Clusters in Ankylosing Spondylitis and Their Association with Disease Activity and Functional Impairment: Data from the PSOAS Cohort. Arthritis Rheumatol 2022: 74 DOI: 10.1136/annrheumdis-2022-eular.5101
    CrossrefGoogle Scholar
  • 13 Österreichische Gesellschaft für Rheumatologie und Rehabilitation. ASPAT (Austrian Spondyloarthritis task Force). Leitfaden „Axiale Spondyloarthritis“ (2019). Im Internet. www.rheumatologie.at/storage/app/media/pdf/2019_11_Leitfaden_axSpA_interaktiv_der_ASPAT.pdf Stand: 25.11.2029
    Google Scholar
  • 14 Braun J, Bollow M, Remlinger G. et al Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 1998; 41: 58-67 DOI: 10.1002/1529-0131(199801)41:1<58::AID-ART8>3.0.CO;2-G.
    CrossrefPubMedGoogle Scholar
  • 15 Costantino F, Talpin A, Said-Nahal R. et al Prevalence of spondyloarthritis in reference to HLA-B27 in the French population: results of the GAZEL cohort. Ann Rheum Dis 2015; 74: 689-693 DOI: 10.1136/annrheumdis-2013-204436.
    CrossrefPubMedGoogle Scholar
  • 16 Baraliakos X, Listing J, Rudwaleit M. et al Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes. Annals of the rheumatic diseases 2007; 66: 910-915 DOI: 10.1136/ard.2006.066415.
    CrossrefPubMedGoogle Scholar
  • 17 Rudwaleit M, van der Heijde D, Landewé R. et al The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Annals of the rheumatic diseases 2009; 68: 777-783 DOI: 10.1136/ard.2009.108233.
    CrossrefPubMedGoogle Scholar
  • 18 van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis and rheumatism 1984; 27: 361-368 DOI: 10.1002/art.1780270401.
    CrossrefPubMedGoogle Scholar
  • 19 Baraliakos X, Richter A, Feldmann D. et al Frequency of MRI changes suggestive of axial spondyloarthritis in the axial skeleton in a large population-based cohort of individuals aged. Ann Rheum Dis 2020; 79: 186-192 DOI: 10.1136/annrheumdis-2019-215553.
    CrossrefPubMedGoogle Scholar
  • 20 Lambert RG, Bakker PA, van der Heijde D. et al Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Annals of the rheumatic diseases 2016; 75: 1958-1963 DOI: 10.1136/annrheumdis-2015-208642.
    CrossrefPubMedGoogle Scholar
  • 21 Diekhoff T, Hermann KG, Greese J. et al Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Ann Rheum Dis 2017; 76: 1502-1508 DOI: 10.1136/annrheumdis-2016-210640.
    CrossrefPubMedGoogle Scholar
  • 22 Rennie WJ, Dhillon SS, Conner-Spady B. et al Magnetic resonance imaging assessment of spinal inflammation in ankylosing spondylitis: standard clinical protocols may omit inflammatory lesions in thoracic vertebrae. Arthritis Rheum 2009; 61: 1187-1193 DOI: 10.1002/art.24561.
    CrossrefPubMedGoogle Scholar
  • 23 Rudwaleit M, Schwarzlose S, Hilgert ES. et al MRI in predicting a major clinical response to anti-tumour necrosis factor treatment in ankylosing spondylitis. Annals of the rheumatic diseases 2008; 67: 1276-1281 DOI: 10.1136/ard.2007.073098.
    CrossrefPubMedGoogle Scholar
  • 24 Baraliakos X, Braun J. Bildgebung bei Patienten mit axialer Spondyloarthritis mit Fokus auf die Knochenneubildung [Imaging in patients with axial spondylarthritis with focus on new bone formation]. Z Rheumatol 2020; 79: 33-39 DOI: 10.1007/s00393-019-00732-y.
    CrossrefPubMedGoogle Scholar
  • 25 Lukas C, Landewé R, Sieper J. et al Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Annals of the rheumatic diseases 2009; 68: 18-24 DOI: 10.1136/ard.2008.094870.
    CrossrefPubMedGoogle Scholar
  • 26 Gwinnutt JM, Wieczorek M, Balanescu A. et al 2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases. Ann Rheum Dis 2023; 82: 48-56 DOI: 10.1136/annrheumdis-2021-222020.
    CrossrefPubMedGoogle Scholar
  • 27 Reiner M, Niermann C, Jekauc D. et al Long-term health benefits of physical activity – a systematic review of longitudinal studies. BMC public health 2013; 13: 813 DOI: 10.1186/1471-2458-13-813.
    CrossrefPubMedGoogle Scholar
  • 28 Liang H, Zhang H, Ji H. et al Effects of home-based exercise intervention on health-related quality of life for patients with ankylosing spondylitis: a meta-analysis. Clin Rheumatol 2015; 34: 1737-1744 DOI: 10.1007/s10067-015-2913-2.
    CrossrefPubMedGoogle Scholar
  • 29 O’Dwyer T, O’Shea F, Wilson F. Exercise therapy for spondyloarthritis: a systematic review. Rheumatol Int 2014; 34: 887-902 DOI: 10.1007/s00296-014-2965-7.
    CrossrefPubMedGoogle Scholar
  • 30 Song IH, Poddubnyy DA, Rudwaleit M. et al Benefits and risks of ankylosing spondylitis treatment with nonsteroidal antiinflammatory drugs. Arthritis Rheum 2008; 58: 929-938 DOI: 10.1002/art.23275.
    CrossrefPubMedGoogle Scholar
  • 31 Baraliakos X, Kiltz U, Peters S. et al Efficiency of treatment with non-steroidal anti-inflammatory drugs according to current recommendations in patients with radiographic and non-radiographic axial spondyloarthritis. Rheumatology (Oxford) 2017; 56: 95-102 DOI: 10.1093/rheumatology/kew367.
    CrossrefPubMedGoogle Scholar
  • 32 van der Heijde D, Deodhar A, Baraliakos X. et al Efficacy and safety of bimekizumab in axial spondyloarthritis: results of two parallel phase 3 randomised controlled trials. Ann Rheum Dis 2023; 82: 515-526 DOI: 10.1136/ard-2022-223595.
    CrossrefPubMedGoogle Scholar
  • 33 Deodhar A, Sliwinska-Stanczyk P, Xu H. et al Tofacitinib for the treatment of ankylosing spondylitis: a phase III, randomised, double-blind, placebo-controlled study. Annals of the rheumatic diseases 2021; 80: 1004-1013 DOI: 10.1136/annrheumdis-2020-219601.
    CrossrefPubMedGoogle Scholar
  • 34 Deodhar A, Van den Bosch F, Poddubnyy D. et al Upadacitinib for the treatment of active non-radiographic axial spondyloarthritis (SELECT-AXIS 2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2022; 400: 369-379 DOI: 10.1016/S0140-6736(22)01212-0.
    CrossrefPubMedGoogle Scholar
  • 35 van der Heijde D, Song IH, Pangan AL. et al Efficacy and safety of upadacitinib in patients with active ankylosing spondylitis (SELECT-AXIS 1): a multicentre, randomised, double-blind, placebo-controlled, phase 2/3 trial. Lancet 2019; 394: 2108-2117 DOI: 10.1016/S0140-6736(19)32534-6.
    CrossrefPubMedGoogle Scholar
  • 36 Navarro-Compán V, Plasencia-Rodríguez C, de Miguel E. et al Switching biological disease-modifying antirheumatic drugs in patients with axial spondyloarthritis: results from a systematic literature review. RMD open 2017; 03: e000524 DOI: 10.1136/rmdopen-2017-000524.
    CrossrefPubMedGoogle Scholar
  • 37 Micheroli R, Tellenbach C, Scherer A. et al Effectiveness of secukinumab versus an alternative TNF inhibitor in patients with axial spondyloarthritis previously exposed to TNF inhibitors in the Swiss Clinical Quality Management cohort. Annals of the rheumatic diseases 2020; 79: 1203-1209 DOI: 10.1136/annrheumdis-2019-215934.
    CrossrefPubMedGoogle Scholar
  • 38 Torgutalp M, Rios Rodriguez V, Proft F. et al Treatment With Tumor Necrosis Factor Inhibitors Is Associated With a Time-Shifted Retardation of Radiographic Sacroiliitis Progression in Patients With Axial Spondyloarthritis: 10-Year Results From the German Spondyloarthritis Inception Cohort. Arthritis Rheumatol 2022; 74: 1515-1523 DOI: 10.1002/art.42144.
    CrossrefPubMedGoogle Scholar
  • 39 Molnar C, Scherer A, Baraliakos X. et al TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort. Ann Rheum Dis 2018; 77: 63-69 DOI: 10.1136/annrheumdis-2017-211544.
    CrossrefPubMedGoogle Scholar
  • 40 Baraliakos X, Østergaard M, Poddubnyy D. et al Effect of Secukinumab versus Adalimumab Biosimilar on Radiographic Progression in Patients with Radiographic Axial Spondyloarthritis: A Randomized Phase IIIb Study. Arthritis Rheumatol 2023: 74 DOI: 10.1136/annrheumdis-2023-eular.301
    CrossrefGoogle Scholar
  • 41 Baraliakos X, Listing J, Brandt J. et al Clinical response to discontinuation of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab. Arthritis Res Ther 2005; 07: R439-R444 DOI: 10.1186/ar1693.
    CrossrefPubMedGoogle Scholar
  • 42 Webers C, Ortolan A, Sepriano A. et al Efficacy and safety of biological DMARDs: a systematic literature review informing the 2022 update of the ASAS-EULAR recommendations for the management of axial spondyloarthritis. Ann Rheum Dis 2023; 82: 130-141 DOI: 10.1136/ard-2022-223298.
    CrossrefPubMedGoogle Scholar
  • 43 Lee SH, Lee GW, Seol YJ. et al Comparison of Outcomes of Total Hip Arthroplasty between Patients with Ankylosing Spondylitis and Avascular Necrosis of the Femoral Head. Clinics in orthopedic surgery 2017; 09: 263-269 DOI: 10.4055/cios.2017.9.3.263.
    CrossrefPubMedGoogle Scholar
  • 44 Wang Y, Xue C, Song K. et al Comparison of loss of correction between PSO and VCD technique in treating thoracolumbar kyphosis secondary to ankylosing spondylitis, a minimum 2 years follow-up. Journal of orthopaedic surgery and research 2019; 14: 137 DOI: 10.1186/s13018-019-1170-5.
    CrossrefPubMedGoogle Scholar