Konventionelle Therapie der ankylosierenden Spondylitis

Zusammenfassung

Die Effektivität nichtsteroidaler Antirheumatika (NSAR) bei der Therapie der ankylosierenden Spondylitis (AS) ist so eindeutig belegt, dass das gute Ansprechen auf NSAR sogar als ein diagnostisches Kriterium der Spondyloarthritiden verwendet wird. Die Gabe von NSAR ist demnach in den aktuellen Therapierichtlinien zur Behandlung der AS als das Standardtherapeutikum angegeben. Bei nicht ausreichender Wirksamkeit und/oder Unverträglichkeit wird als nächst folgendes Therapieregime die Gabe von TNF-alpha-Blockern vorgeschlagen. Als weitere konventionelle und wichtigste flankierende Maßnahme zur Therapie der AS wird Physiotherapie angesehen. Andere konventionelle Therapeutika wie krankheitsmodifizierende Antirheumatika (DMARDs) oder Kortikosteroide spielen eine untergeordnete Rolle und werden lediglich bei peripherer Beteiligung beziehungsweise hauptsächlich zur Lokaltherapie vorgeschlagen. Im Folgenden wird auf die Hintergründe dieser Behandlungsrichtlinien für die konventionellen Therapien näher eingegangen. Es werden weiterhin die Therapie von extraartikulären Manifestationen, Osteoporose und chirurgische Interventionen bei AS diskutiert.

Summary

The efficacy of nonsteroidal anti-infammatory drugs (NSAIDs) in the therapy of AS is well known, a clear improvement of symptoms after NSAID intake has even been chosen as an item among the diagnostic criteria for Spondyloarthritides. Therefore NSAIDs are stated to be standard therapy within the actual treatment guidelines for AS. If not sufficient and/or if patients are intolerant to NSAIDs a therapy with TNF blocking agents is suggested. An additional and important accompanying conventional treatment regime of AS is physical therapy. Other conventional drugs like disease modifying antirheumatic drugs (DMARDs) or corticosteroids are of less importance and only suggested in patients with peripheral involvement or as local therapy. This manuscrip gives background informations on these guidelines for the conventional therapies. Therapy of extraarticular manifestations, osteoporosis and surgical interventions in AS will be discussed.

Schlüsselwörter

Ankylosierende Spondylitis - konventionelle Therapie - nichtsteroidale Antirheumatika

Keywords

Ankylosing spondylitis - conventional therapy - nonsteroidal antirheumatic drugs

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