Download PDF
Aktuelle Rheumatologie 2009; 34(3): 157-163
DOI: 10.1055/s-0029-1225368
Übersichtsarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Krankheitsaktivitätsmessung im klinischen Alltag bei Spondyloarthritiden

Disease Activity Measures for Spondyloarthritides in Clinical PracticeJ. Hermann 1 , D. Zauner 1 , W. Graninger 1
  • 1Divison of Rheumatology, Department of Internal Medicine, Graz, Austria
Further Information

Publication History

Publication Date:
07 July 2009 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Spondyloarthritiden stellen eine Gruppe von entzündlichen Wirbelsäulen- und Gelenkserkrankungen mit zahlreichen extraartikulären Manifestationen dar. Die Beurteilung der Krankheitsaktivität ist deshalb aufwendig und zeitintensiv, wobei nur für die ankylosierende Spondylitis und die Psoriasisarthritis ausreichend validierte Parameter zur Verfügung stehen. Für die Beurteilung der Krankheitsaktivität der AS im klinischen Alltag können neben dem zusammengesetzten Bath Ankylosing Spondylitis Disease Activity Index auch die Einzelparameter nächtlicher Rückenschmerz, Intensität und Dauer der Morgensteifigkeit und Patienten-orientierte Beurteilung der globalen Krankheitsaktivität empfohlen werden. Zur Beurteilung der Krankheitsaktivität der Psoriasisarthritis sollten im klinischen Alltag die Aktivität der peripheren Arthritis, die Aktivität der Hauteffloreszenzen und die Patienten-orientierte globale Beurteilung der Krankheitsaktivität herangezogen werden.

Abstract

Spondyloarthritides are a group of inflammatory rheumatic diseases that affect the axial and peripheral skeleton and also extraskeletal organs. To comprehensively estimate the activity of the diseases, a whole range of parameters covering all aspects of the disease would therefore be necessary but valid parameters have been developed only for patients with ankylosing spondylitis and psoriatic arthritis. It has been shown that the Bath ankylosing spondylitis activity score as a composite measure and single items such as nocturnal pain, intensity and duration of morning stiffness, patients global assessment of disease activity and the Maastricht ankylosing spondylitis enthesitis index are valid parameters to estimate AS disease activity in clinical practice. To estimate the disease activity of psoriatic arthritis in clinical practice, recommended parameters include the activity of peripheral arthritis and psoriasis, patients’ global assessment of disease activity, and physical function.

Schlüsselwörter

Spondyoarthritiden - Krankheitsaktivität - Klinisch - Instrumente

Key words

spondyloarthritides - disease activity - clinical practice - measures of disease activity

Literatur

  • 1 Stone MA, Pomeroy E, Keat A. et al . Assessment of the impact of flares in ankylosing spondylitis disease activity using the Flare Illustration.  Rheumatology (Oxford). 2008;  47 1213-1218
    CrossrefPubMedGoogle Scholar
  • 2 Boonen A, Chorus A, Miedema H. et al . Employment, work disability, and work days lost in patients with ankylosing spondylitis: a cross sectional study of Dutch patients.  Ann Rheum Dis. 2001;  60 353-358
    CrossrefPubMedGoogle Scholar
  • 3 Braun J, Baraliakos X, Listing J. et al . Persistent clinical efficacy and safety of anti-tumour necrosis factor alpha therapy with infliximab in patients with ankylosing spondylitis over 5 years: evidence for different types of response.  Ann Rheum Dis. 2008;  67 340-345
    PubMedGoogle Scholar
  • 4 Davis Jr JC, van der Heijde DM, Braun J. et al . Efficacy and safety of up to 192 weeks of etanercept therapy in patients with ankylosing spondylitis.  Ann Rheum Dis. 2008;  67 346-352
    PubMedGoogle Scholar
  • 5 van der Heijde D, Kivitz A, Schiff MH. et al . Efficacy and safety of adalimumab in patients with ankylosing spondylitis: results of a multicenter, randomized, double-blind, placebo-controlled trial.  Arthritis Rheum. 2006;  54 2136-2146
    CrossrefPubMedGoogle Scholar
  • 6 van der Heijde D, Calin A, Dougados M. et al . Selection of instruments in the core set for DC-ART, SMARD, physical therapy, and clinical record keeping in ankylosing spondylitis. Progress report of the ASAS Working Group. Assessments in Ankylosing Spondylitis.  J Rheumatol. 1999;  26 951-954
    PubMedGoogle Scholar
  • 7 Garrett S, Jenkinson T, Kennedy LG. et al . A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index.  J Rheumatol. 1994;  21 2286-2291
    PubMedGoogle Scholar
  • 8 Calin A, Garrett S, Whitelock H. et al . A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index.  J Rheumatol. 1994;  21 2281-2285
    PubMedGoogle Scholar
  • 9 Jenkinson TR, Mallorie PA, Whitelock HC. et al . Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index.  J Rheumatol. 1994;  21 1694-1698
    PubMedGoogle Scholar
  • 10 Rudwaleit M, Metter A, Listing J. et al . Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria.  Arthritis Rheum. 2006;  54 569-578
    CrossrefPubMedGoogle Scholar
  • 11 Auleley GR, Benbouazza K, Spoorenberg A. et al . Evaluation of the smallest detectable difference in outcome or process variables in ankylosing spondylitis.  Arthritis Rheum. 2002;  47 582-587
    CrossrefPubMedGoogle Scholar
  • 12 Viitanen JV, Heikkila S, Kokko ML. et al . Clinical assessment of spinal mobility measurements in ankylosing spondylitis: a compact set for follow-up and trials?.  Clin Rheumatol. 2000;  19 131-137
    CrossrefPubMedGoogle Scholar
  • 13 Jones SD, Porter J, Garrett SL. et al . A new scoring system for the Bath Ankylosing Spondylitis Metrology Index (BASMI).  J Rheumatol. 1995;  22 1609
    PubMedGoogle Scholar
  • 14 van der Heijde D, Landewe R, Feldtkeller E. Proposal of a linear definition of the Bath Ankylosing Spondylitis Metrology Index (BASMI) and comparison with the 2-step and 10-step definitions.  Ann Rheum Dis. 2008;  67 489-493
    PubMedGoogle Scholar
  • 15 Dougados M, Gueguen A, Nakache JP. et al . Evaluation of a functional index for patients with ankylosing spondylitis.  J Rheumatol. 1990;  17 1254-1255
    PubMedGoogle Scholar
  • 16 Benjamin M, Moriggl B, Brenner E. et al . The “enthesis organ” concept: why enthesopathies may not present as focal insertional disorders.  Arthritis Rheum. 2004;  50 3306-3313
    CrossrefPubMedGoogle Scholar
  • 17 Moriggl B, Kumai T, Milz S. et al . The structure and histopathology of the “enthesis organ” at the navicular insertion of the tendon of tibialis posterior.  J Rheumatol. 2003;  30 508-517
    PubMedGoogle Scholar
  • 18 Braun J, Brandt J, Listing J. et al . Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial.  Lancet. 2002;  359 1187-1193
    CrossrefPubMedGoogle Scholar
  • 19 Heuft-Dorenbosch L, Spoorenberg A, van Tubergen A. et al . Assessment of enthesitis in ankylosing spondylitis.  Ann Rheum Dis. 2003;  62 127-132
    CrossrefPubMedGoogle Scholar
  • 20 Mander M, Simpson JM, McLellan A. et al . Studies with an enthesis index as a method of clinical assessment in ankylosing spondylitis.  Ann Rheum Dis. 1987;  46 197-202
    CrossrefPubMedGoogle Scholar
  • 21 Balint PV, Kane D, Wilson H. et al . Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy.  Ann Rheum Dis. 2002;  61 905-910
    CrossrefPubMedGoogle Scholar
  • 22 Barozzi L, Olivieri I, De Matteis M. et al . Seronegative spondylarthropathies: imaging of spondylitis, enthesitis and dactylitis.  Eur J Radiol. 1998;  27 ((Suppl 1)) S12-S17
    CrossrefPubMedGoogle Scholar
  • 23 Hermann KGA, Eshed I, Bollow M. Bildgebung der Enthesitis: Ein neues Feld für den Radiologen?.  Fortschr Röntgenstr. 2006;  178 578-589
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Olivieri I, Barozzi L, Padula A. et al . Retrocalcaneal bursitis in spondyloarthropathy: assessment by ultrasonography and magnetic resonance imaging.  J Rheumatol. 1998;  25 1352-1357
    PubMedGoogle Scholar
  • 25 Spoorenberg A, van der Heijde D, de Klerk E. et al . Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis.  J Rheumatol. 1999;  26 980-984
    PubMedGoogle Scholar
  • 26 Ruof J, Stucki G. Validity aspects of erythrocyte sedimentation rate and C-reactive protein in ankylosing spondylitis: a literature review.  J Rheumatol. 1999;  26 966-970
    PubMedGoogle Scholar
  • 27 Dernis-Labous E, Messow M, Dougados M. Assessment of fatigue in the management of patients with ankylosing spondylitis.  Rheumatology (Oxford). 2003;  42 1523-1528
    CrossrefPubMedGoogle Scholar
  • 28 Ward MM. Health-related quality of life in ankylosing spondylitis: a survey of 175 patients.  Arthritis Care Res. 1999;  12 247-255
    CrossrefPubMedGoogle Scholar
  • 29 van Tubergen A, Coenen J, Landewe R. et al . Assessment of fatigue in patients with ankylosing spondylitis: a psychometric analysis.  Arthritis Rheum. 2002;  47 8-16
    CrossrefPubMedGoogle Scholar
  • 30 Jones SD, Steiner A, Garrett SL. et al . The Bath Ankylosing Spondylitis Patient Global Score (BAS-G).  Br J Rheumatol. 1996;  35 66-71
    CrossrefPubMedGoogle Scholar
  • 31 Calin A, Nakache JP, Gueguen A. et al . Defining disease activity in ankylosing spondylitis: is a combination of variables (Bath Ankylosing Spondylitis Disease Activity Index) an appropriate instrument?.  Rheumatology (Oxford). 1999;  38 878-882
    CrossrefPubMedGoogle Scholar
  • 32 Cohen JD, Cunin P, Farrenq V. et al . Estimation of the Bath Ankylosing Spondylitis Disease Activity Index cutoff for perceived symptom relief in patients with spondyloarthropathies.  J Rheumatol. 2006;  33 79-81
    PubMedGoogle Scholar
  • 33 Lukas C, Landewe R, Sieper J. et al . Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis.  Ann Rheum Dis. 2009;  68 18-24
    PubMedGoogle Scholar
  • 34 Anderson JJ, Baron G, van der Heijde D. et al . Ankylosing spondylitis assessment group preliminary definition of short-term improvement in ankylosing spondylitis.  Arthritis Rheum. 2001;  44 1876-1886
    CrossrefPubMedGoogle Scholar
  • 35 Brandt J, Listing J, Sieper J. et al . Development and preselection of criteria for short term improvement after anti-TNF alpha treatment in ankylosing spondylitis.  Ann Rheum Dis. 2004;  63 1438-1444
    CrossrefPubMedGoogle Scholar
  • 36 Gladman DD, Antoni C, Mease P. et al . Psoriatic arthritis: epidemiology, clinical features, course, and outcome.  Ann Rheum Dis. 2005;  64 ((Suppl 2)) ii14-ii17
    CrossrefPubMedGoogle Scholar
  • 37 Gladman DD, Brubacher B, Buskila D. et al . Psoriatic spondyloarthropathy in men and women: a clinical, radiographic, and HLA study.  Clin Invest Med.  1992;  15 371-375
    PubMedGoogle Scholar
  • 38 Gladman DD, Mease PJ, Strand V. et al . Consensus on a core set of domains for psoriatic arthritis.  J Rheumatol. 2007;  34 1167-1170
    PubMedGoogle Scholar
  • 39 Gladman DD, Farewell V, Buskila D. et al . Reliability of measurements of active and damaged joints in psoriatic arthritis.  J Rheumatol. 1990;  17 62-64
    PubMedGoogle Scholar
  • 40 Fuchs HA, Pincus T. Reduced joint counts in controlled clinical trials in rheumatoid arthritis.  Arthritis Rheum. 1994;  37 470-475
    CrossrefPubMedGoogle Scholar
  • 41 Leeb BF, Andel I, Sautner J. et al . The Disease Activity Score in 28 joints in rheumatoid arthritis and psoriatic arthritis patients.  Arthritis Rheum. 2007;  57 256-260
    CrossrefPubMedGoogle Scholar
  • 42 Gladman DD, Farewell VT, Wong K. et al . Mortality studies in psoriatic arthritis: results from a single outpatient center. II. Prognostic indicators for death.  Arthritis Rheum. 1998;  41 1103-1110
    CrossrefPubMedGoogle Scholar
  • 43 Husted JA, Gladman DD, Farewell VT. et al . Health-related quality of life of patients with psoriatic arthritis: a comparison with patients with rheumatoid arthritis.  Arthritis Rheum. 2001;  45 151-158
    CrossrefPubMedGoogle Scholar
  • 44 Clegg DO, Reda DJ, Mejias E. et al . Comparison of sulfasalazine and placebo in the treatment of psoriatic arthritis. A Department of Veterans Affairs Cooperative Study.  Arthritis Rheum. 1996;  39 2013-2020
    CrossrefPubMedGoogle Scholar
  • 45 Felson DT, Anderson JJ, Boers M. et al . American College of Rheumatology. Preliminary definition of improvement in rheumatoid arthritis.  Arthritis Rheum. 1995;  38 727-735
    CrossrefPubMedGoogle Scholar
  • 46 Ashcroft DM, Wan Po AL, Williams HC. et al . Clinical measures of disease severity and outcome in psoriasis: a critical appraisal of their quality.  Br J Dermatol. 1999;  141 185-191
    CrossrefPubMedGoogle Scholar
  • 47 Rich P, Scher RK. Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis.  J Am Acad Dermatol. 2003;  49 206-212
    CrossrefPubMedGoogle Scholar
  • 48 Cassell SE, Bieber JD, Rich P. et al . The modified Nail Psoriasis Severity Index: validation of an instrument to assess psoriatic nail involvement in patients with psoriatic arthritis.  J Rheumatol. 2007;  34 123-129
    PubMedGoogle Scholar
  • 49 Gladman DD, Helliwell P, Mease PJ. et al . Assessment of patients with psoriatic arthritis: a review of currently available measures.  Arthritis Rheum. 2004;  50 24-35
    CrossrefPubMedGoogle Scholar
  • 50 Fries JF, Spitz P, Kraines RG. et al . Measurement of patient outcome in arthritis.  Arthritis Rheum. 1980;  23 137-145
    CrossrefPubMedGoogle Scholar
  • 51 Taylor WJ, McPherson KM. Using Rasch analysis to compare the psychometric properties of the Short Form 36 physical function score and the Health Assessment Questionnaire disability index in patients with psoriatic arthritis and rheumatoid arthritis.  Arthritis Rheum. 2007;  57 723-729
    CrossrefPubMedGoogle Scholar
  • 52 Toivanen A. Reactive Arthritis. In: Klippel JH, Dieppe PA eds. Rheumatology. London: Mosby Year Book Europe 1994: 4.9: 1-8
    Google Scholar
  • 53 Eberl G, Studnicka-Benke A, Hitzelhammer H. et al . Development of a disease activity index for the assessment of reactive arthritis (DAREA).  Rheumatology (Oxford). 2000;  39 148-155
    CrossrefPubMedGoogle Scholar

Korrespondenzadresse

Dr. Josef Hermann

Division of Rheumatology

Internal Medicine

Auenbruggerplatz 15

8036 Graz

Austria

Phone: +43/316/385 77 79

Fax: +43/316/385 78 13

Email: josef.hermann@medunigraz.at

      >