Aktuelle Rheumatologie 2013; 38(02): 92-96
DOI: 10.1055/s-0032-1327617
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Das Konzept der nicht-röntgenologischen axialen Spondyloarthritis

The Concept of Non-Radiographic Axial Spondyloarthritis
U. Kiltz
1   Rheumazentrum Ruhrgebiet, Rheumatologie, Herne
,
X. Baraliakos
1   Rheumazentrum Ruhrgebiet, Rheumatologie, Herne
,
J. Braun
2   Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
22. Januar 2013 (online)

Zusammenfassung

Der Begriff Spondyloarthritis (SpA) umfasst eine Gruppe von rheumatischen Erkrankungen, die neben einer Entzündung des Achsenskelettes (Sakroiliitis, Spondylitis) auch durch eine Entzündung peripherer Gelenke (Arthritis) und Sehnenansätze (Enthesitis) charakterisiert ist. Die SpA wird heute je nach im Vordergrund stehender klinischer Symptomatik in eine prädominant axiale und in eine prädominant periphere Form eingeteilt. Bei der axialen Form unterscheidet man die ankylosierende Spondylitis (AS), die durch strukturelle Veränderungen in den Sakroiliakalgelenken im konventionellen Röntgenbild charakterisiert ist, von der sogenannten nicht-röntgenologischen Form, bei der definitionsgemäß keine derartigen Veränderungen vorliegen. In diesem Übersichtsartikel werden neben den klinischen Charakteristika vor allem die Diagnostik und Therapie der axialen SpA inklusive der nicht-röntgenologischen axialen SpA im Vergleich zur klassischen AS dargestellt.

Abstract

The characteristic features of spondyloarthritis are inflammation of the axial skeleton (sacroiliitis, spondylitis) and inflammation of peripheral joints (arthritis) and entheses (enthesitis). According to the leading clinical symptom, SpA can be differentiated in either a predominant axial or a peripheral form. Axial SpA is further subdivided in the classical ankylosing spondylitis and non-radiographic axial SpA (nr-axSpA). These subsets are differentiated by the presence or absence of structural changes on conventional X-rays of the sacroiliac joints. Here we describe the clinical symptoms, the diagnosis and therapy for patients with axial SpA including patients with nr-axSpA.

 
  • Literatur

  • 1 Rudwaleit M, van der Heijde D, Landewè 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
  • 2 Rudwaleit M, van der Heijde D, Landewè 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
  • 3 Braun J, Baraliakos X. Imaging of axial spondyloarthritisincluding ankylosing spondylitis. Ann Rheum Dis 2011; 70: i97-i102
  • 4 Braun J, Inman R. Clinical significance of inflammatory back pain for diagnosis and screening of patients with axial spondyloarthrits. Ann Rheum Dis 2010; 69: 1264-1268
  • 5 Baraliakos X, Lisitng J, Rudwaliet M et al. Development of radiographic scoring tool for ankylosing spondylitis only based on bone formation: addition of the thoracis spine improves sensitivity to change. Arthritis Rheum 2009; 61: 764-771
  • 6 VanderCryussen B, Ribbens C, Boonen A et al. The epidemiology of ankylosing spondylitis and the commencement of anti-TNF therapy in daily rheumatology practice. Ann Rheum Dis 2007; 66: 1072
  • 7 Rudwaleit M, Haibel H, Baraliakos X et al. The early disease stage in spondyloarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum 2009; 60: 717-727
  • 8 Dougados M, d’Agostino MA, Benessiano J et al. The DESIR cohort: a 10-year follow-up of early inflammatory back pain in France: study design and baseline characteristics of the 708 recruited patients. Joint Bone Spine 2011; 78: 598-603
  • 9 Kiltz U, Baraliakos X, Karakostas P et al. Patients with with non-radiographic axial spondyloarthritis differ from patients with ankylosing spondylitis in several aspects. Arthritis Care Res 2012; 64: 1415-1422
  • 10 Kiltz U, Baraliakos X, Karakostas P et al. The degree of spinal inflammation is similar in patients with axial spondyloarthritis who report high or low levels of disease activity: a cohort study. Ann Rheum Dis 2012; 71: 1207-1211
  • 11 Peters M, van Eijk I, Smulders Y et al. Signs of Accelerated Preclinical Atherosclerosis in Patients with Ankylosing Spondylitis. J Rheumatol 2010; 37: 161-166
  • 12 Vosse D, Landewé R, van der Heijde D et al. Ankylosing Spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum 2009; 68: 1839-1842
  • 13 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 Rheum 1984; 27: 361-368
  • 14 Feldtkeller E, Khan MA, van der Heijde D et al. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 2003; 23: 61-68
  • 15 Doran M, Brophy S, Mackay K et al. Predictors of Longterm Outcome in Ankylosing Spondylitis. J Rheumatol 2003; 30: 316-320
  • 16 Ward MM. Predictors of the progression of functional disability in patients with ankylosing spondylitis. J Rheumatol 2002; 29: 1420-1425
  • 17 Poddubnyy D, Rudwaleit M, Haibel H et al. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis 2011; 70: 1369-1374
  • 18 Heuft-Dorenbosch L, Landewe R, Weijers R et al. Performance of various criteria sets in patients with inflammatory back pain of short duration; the Maastricht early spondyloarthritis clinic. Ann Rheum Dis 2007; 66 (92) 98
  • 19 Sampaio-Barros P, Bortolutzzo AB, Conde RA et al. Undifferentiated spondyloarthritis: a longterm followup. J Rheumatol 2012; 37: 1195-1199
  • 20 Braun J, van den Berg R, Baraliakos X et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011; 70: 896-904
  • 21 Van der Heijde D, Sieper J, Maksymowych WP et al. 2010 update of the international ASAS recommendations for the use of anti-TNF agents in patients with spondyloarthritis. Ann Rheum Dis 2011; 70: 905-908
  • 22 Kiltz U, van der Heijde D, Mielants H et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis: the patient version. Ann Rheum Dis 2009; 68: 1381-1386
  • 23 Kiltz U, Feldtkeller E, Braun J. Deutsche Patientenversion der Empfehlungen für das Management des Morbus Bechterew gemäß ASAS/EULAR. Z Rheumatol 2010; 69: 171-179
  • 24 Braun J, Zochling J, Märker-Hermann E et al. Empfehlungen für das Management der ankylosierenden Spondylitis gemäß ASAS/EULAR Evaluation im deutschsprachigen Raum. Z Rheumatol 2006; 65: 728-742
  • 25 Haibel H. Efficacy of adalimumab in the treatment of axial spondyloarthritis without radiographically defined sacroiliitis: results of a twelve-week randomized, double-blind, placebo-controlled trial followed by an open-label extension up to week fifty-two. Arthritis Rheum 2008; 58: 1981-1991
  • 26 Barkham N, Keen HI, Coates LC et al. Clinical and imaging efficacy of infliximab in HLA-B27-Positive patients with magnetic resonance imaging-determined early sacroiliitis. Arthritis Rheum Apr 2009; 60 (04) 946-954
  • 27 Song IH, Herrmann KG, Haibel H et al. Effects of Etanercept versus sulfasalazine in early axial Spondyloarthritis on active inflammatory lesions as detected by whole-body MRI (ESTHER):a 48-week randomized controlled trial. Ann Rheum Dis 2011; 70: 590-599