Zusammenfassung
Die ankylosierende Spondylitis (AS) gilt als Prototyp der Spondylarthropathien, welche
mit einer Prävalenz von 2 % zu den häufigsten rheumatischen Erkrankungen gerechnet
werden. Die Spondylarthropathie umfasst die 5 Entitäten AS, reaktive Arthritis, Psoriasis
arthropathica, enteropathische Arthritis bei Morbus Crohn und Colitis ulcerosa und
die undifferenzierte Spondylarthropathie. Bei 99 % der Patienten mit AS sind die ersten
pathologischen Befunde an den Sakroiliakalgelenken zu finden. Die zur Diagnose einer
AS geforderten Röntgenbefunde treten erst mit einer Latenz von 5 - 9 Jahren nach Beginn
der klinischen Symptome in Erscheinung. Mit Hilfe der MRT der Sakroiliakalgelenke
lassen sich sowohl chronisch-entzündliche Veränderungen (Erosionen, Sklerosierungen,
Knochenbrücken) als auch akut-entzündliche Veränderungen (Synovitiden, Kapsulitiden,
Osteitiden) sicher nachweisen und bezüglich ihrer Chronizität und Akuität graduieren.
Enthesitiden der Ligamenta interossea des Spatium retroarticulare gehören zum Bild
der AS. Eine Spondylodiszitis (Andersson 1937) kann als entzündliche und als nichtentzündliche
Form (transdiskaler Ermüdungsbruch) auftreten. Zur Ankylosierung führende Entzündungen
der Facetten- und der kostospinalen Gelenke sind für die AS typisch. Veränderungen
der Wirbelkörper finden sich als Spondylitis anterior (Romanus 1952), posterior und
marginalis. Charakteristisch für alle Spondylarthropathien sind darüberhinaus asymmetrische
Synovitiden an den großen Gelenken vor allem der unteren Extremität (Gonarthritis,
Coxitis, Tarsitis, periphere Oligoarthritis), die Fibroostitis rheumatica (pelvine
Enthesitis, Calcaneopathia rheumatica) und die Peri- und Synchondritiden der Symphysis
pubica und der Synchondrosis sternalis. Da sich bei der AS frühe entzündliche Veränderungen
an der Wirbelsäule und an den extravertebralen Manifestationsorten in der MRT vor
deren Auftreten im Röntgenbild nachweisen lassen und damit die diagnostische Lücke
geschlossen werden konnte, empfiehlt sich bei neuen therapeutischen Optionen mit den
sogenannten „Biologicals” der frühe Einsatz der MRT zur Diagnostik und Verlaufskontrolle.
Abstract
Ankylosing spondylitis (AS) is the prototypical form of the spondyloarthropathies,
which at a prevalence of 2 % is among the most frequent rheumatic diseases. Spondyloarthropathy
comprises the following five disorders: AS, reactive arthritis, psoriatic arthritis,
enteropathic arthritis in Crohn's disease, and ulcerosing colitis as well as undifferentiated
spondyloarthropathy. In 99 % of the patients with AS initial abnormal findings affect
the sacroiliac joints. The radiographic changes required for diagnosing AS occur as
late as 5 - 9 years after the onset of clinical symptoms. MRI of the sacroiliac joints
reliably demonstrates both chronic inflammatory changes (erosions, sclerotic changes,
bone bridges) and acute inflammatory changes (synovitis, capsulitis, osteitis) and
allows for grading the chronicity and acuity of such changes. Enthesitis of the interosseous
ligaments of the retroarticular space is a manifestation of AS. Spondylodiscitis (Andersson
1937) may occur as an inflammatory or non-inflammatory process (transdiscal fatigue
fracture). Inflammations of the facet and costospinal joints developing into ankylosis
are typical of AS. Changes of the vertebral bodies occur as anterior (Romanus 1952),
posterior, and marginal spondylitis. All forms of spondyloarthropathies are furthermore
characterized by asymmetrical synovitis of the large joints, particularly of the legs
(gonarthritis, coxitis, tarsitis, peripheral oligoarthritis), rheumatic fibroosteitis
(pelvic enthesitis, rheumatic calcaneopathy), and peri- and synchondritis of the pubic
symphisis and sternal synchondrosis. Since early inflammatory changes of the spinal
column and of the extravertebral localizations in AS are demonstrated by MRI before
they become apparent on radiographs, and thereby the diagnostic gap could be closed,
the early use of MRI for diagnostic and follow-up is commendable, when new therapeutical
options like the so-called “biologicals” are employed.
Schlüsselwörter
MRT - Sakroiliitis - Spondylodiszitis - Spondylitis - Spondylarthritis - Fibroostitis
Key words
MRI - sacroiliitis - spondylodiscitis - spondylitis - spondyloarthritis - fibroosteitis
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Priv.-Doz. Dr. med. Matthias Bollow
Augusta-Kranken-Anstalt, Institut für Radiologie
Bergstraße 26
44791 Bochum
Telefon: + 49(0)234/517-2750
Fax: + 49(0)234/517-2796
eMail: bollow@augusta-bochum.de
