Spondyloarthritiden – Klinische Manifestation, Klassifikationskriterien und Behandlungskonzepte

Spondyloarthritiden (SpA) sind eine Gruppe von entzündlich-rheumatischen Erkrankungen, die entweder nach der im Vordergrund stehenden klinischen Manifestation oder nach Subtypen unterschieden werden. Der wichtigste Subtyp ist die ankylosierende Spondylitis (AS). Die anderen Subtypen sind die SpA bei Psoriasis, nach vorausgehenden Infektionen (ReA), assoziiert mit chronisch-entzündlichen Darmerkrankungen (SpACED) und die undifferenzierte SpA (uSpA). Die wichtigsten klinischen Symptome von SpA sind der entzündliche Rückenschmerz und die periphere, meist asymmetrische Oligoarthritis und Enthesitis. Der stärkste genetische Faktor, das HLA B27, ist bei ca. 90 % der AS-Patienten vorhanden. Weitere genetische Faktoren wurden vor Kurzem identifiziert: ERAP-1 und IL 23R sowie IL-1-Polymorphismen zeigen eine z. T. starke Assoziation zu SpA. Die konventionelle medikamentöse Empfehlung besteht im Wesentlichen aus nicht-steroidalen Antiphlogistika (NSAR), v. a. bei Patienten mit peripherer Arthritis ist ein Behandlungsversuch mit Sulfasalazin gerechtfertigt. Patienten mit persistierend erhöhter Entzündungsaktivität profitieren von einer Therapie mit TNF-Blockern. Die Physiotherapie ist von großer Bedeutung für den generellen Behandlungsansatz bei SpA-Patienten, vor allem bei ankylosierender Spondylitis.

Spondyloarthritides (SpA) are a group of inflammatory rheumatic diseases that are differentiated by either the principle clinical manifestations or according to subtypes. The most important subtype is ankylosing spondylitis (AS). The other subtypes are SpA with psoriasis, after previous infections (ReA), associated with chronic inflammatory bowel diseases (SpACED) and, above all, peripheral undifferentiated SpA (uSpA). The most important symptoms of SpA are inflammatory back pain and peripherally, usually asymmetric oligoarthritis and enthesitis. The strongest genetic factor, HLA B27, is present in ca. 90% of the AS patients. Further genetic factors were identified just recently: ERAP-1 and IL 23R as well as IL-1 polymorphisms in part show a strong association to SpA. The conventional drug recommendations consist mainly of non-steroidal anti-rheumatics (NSAR), a therapeutic trial with sulfasalazine is justified, especially for patients with peripheral arthritis. Patients with persisting elevated inflammatory activity profit from therapy with TNF blockers. Physiotherapy is of major significance for the general treatment approach in SpA, above all those with ankylosing spondylitis.

Key words

Spondyloarthritides - ankylosing spondylitis - HLA B27 - NSAR - TNF blocker - physiotherapy

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