Modernes Konzept der axialen Spondyloarthritis

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 nichtröntgenologischen Form, bei der definitionsgemäß keine derartigen Veränderungen vorliegen. In diesem Übersichtsartikel werden neben den klinischen Charakteristika vor allem die Diagnostik (inklusive Bildgebung) und Therapie der axialen SpA, einschließlich der Darstellung der nichtröntgenologischen axialen SpA im Vergleich zur klassischen AS dargestellt.

Summary

The term spondyloarthritis (SpA) refers to a group of rheumatic disorders which are characterized by inflammatory changes in the axial skeleton (sacroiliitis, spondylitis) but also in the peripheral joints (arthritis) and tendons (enthesitis). SpA is nowadays subdivided into a predominantly axial and a predominantly peripheral form, depending on the leading clinical symptoms. The axial form is comprised by ankylosing spondylitis (AS), which is characterized by structural changes in the sacroiliac joints as detected by conventional radiography, and by the non-radiographic form, where such changes are not being detected. In this overview article we describe the clinical characteristics, the diagnostic procedures and the treatment options for axial SpA, including the comparison between nr-axSpA and AS.

Schlüsselwörter

Axiale Spondyloarthritis - ankylosierende Spondylitis - nichtröntgenologische axiale Spondyloarthritis - MRT

Keywords

Axial spondyloarthritis - ankylosing spondylitis - non-radiographic axial spondyloarthritis - MRI

• Literatur

• 1 Rudwaleit M. 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 (06) 777-783.
• 2 Braun J, Inman R. Clinical significance of inflammatory back pain for diagnosis and screening of patients with axial spondyloarthritis. Ann Rheum Dis 2010; 69 (07) 1264-1268.
• 3 Baraliakos X. et al. Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes. Ann Rheum Dis 2007; 66 (07) 910-915.
• 4 Vander Cruyssen B. et al. The epidemiology of ankylosing spondylitis and the commencement of anti-TNF therapy in daily rheumatology practice. Ann Rheum Dis 2007; 66 (08) 1072-1077.
• 5 Dougados M. 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 (06) 598-603.
• 6 Kiltz U. 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.
• 7 Kiltz U. et al. Patients with non-radiographic axial spondyloarthritis differ from patients with ankylosing spondylitis in several aspects. Arthritis Care Res (Hoboken) 2012; 64: 1415-1422.
• 8 Rudwaleit M. et al. The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum 2009; 60 (03) 717-727.
• 9 Peters MJ. et al. Signs of accelerated preclinical atherosclerosis in patients with ankylosing spondylitis. J Rheumatol 2010; 37 (01) 161-166.
• 10 Vosse D. et al. Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis 2009; 68 (12) 1839-1842.
• 11 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 (04) 361-368.
• 12 Feldtkeller E. et al. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 2003; 23 (02) 61-66.
• 13 Rudwaleit M. et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 2009; 68 (10) 1520-1527.
• 14 Hermann KG. et al. Descriptions of Spinal Magnetic Resonance Imaging (MRI) Lesions and Definition of a Positive MRI of the Spine in Axial Spondyloarthritis (SpA) – A Consensual Approach by the ASAS/ OMERACT MRI Study Group. Ann Rheum Dis 2012; 71 (08) 1278-1288.
• 15 Braun J. et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 1998; 41 (01) 58-67.
• 16 Rudwaleit M. et al. How to diagnose axial spondyloarthritis early. Ann Rheum Dis 2004; 63 (05) 535-543.
• 17 Braun A. et al. Identifying patients with axial spondyloarthritis in primary care: how useful are items indicative of inflammatory back pain?. Ann Rheum Dis. 2011 doi:
• 18 Sieper J, Rudwaleit M. Early referral recommendations for ankylosing spondylitis (including preradiographic and radiographic forms) in primary care. Ann Rheum Dis 2005; 64 (05) 659-663.
• 19 Doran MF. et al. Predictors of longterm outcome in ankylosing spondylitis. J Rheumatol 2003; 30 (02) 316-320.
• 20 Poddubnyy D. et al. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis 2011; 70 (08) 1369-1374.
• 21 Ward MM. Predictors of the progression of functional disability in patients with ankylosing spondylitis. J Rheumatol 2002; 29 (07) 1420-1425.
• 22 Heuft-Dorenbosch L. 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 (01) 92-98.
• 23 Heldmann F. et al. The European ankylosing spondylitis infliximab cohort (EASIC): a European multicentre study of long term outcomes in patients with ankylosing spondylitis treated with infliximab. Clin Exp Rheumatol 2011; 29 (04) 672-680.
• 24 Braun J. et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011; 70 (06) 896-904.
• 25 van der Heijde D. et al. 2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis. Ann Rheum Dis 2011; 70 (06) 905-908.
• 26 Kiltz U, Feldtkeller E, Braun J. [German patient version of the ASAS/EULAR recommendations for the management of ankylosing spondylitis]. Z Rheumatol 2010; 69 (02) 171-174 176–179.
• 27 Kiltz U. et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis: the patient version. Ann Rheum Dis 2009; 68 (09) 1381-1386.
• 28 Kiltz U, Sieper J, Braun J. [ASAS/EULAR recommendations for the management of ankylosing spondylitis: Evaluation of the 2010 update in the German-speaking area.]. Z Rheumatol 2013; 72 (01) 71-80.
• 29 Barkham N. et al. Clinical and imaging efficacy of infliximab in HLA-B27-Positive patients with magnetic resonance imaging-determined early sacroiliitis. Arthritis Rheum 2009; 60 (04) 946-954.
• 30 Haibel H. et al. Preliminary results of an open-label, 12 week trial of adalimumab in the treatment of active ankylosing spondylitis. Ann Rheum Dis 2004; 64 (Suppl. I): 399.
• 31 Sieper J. et al. Efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis: results of a randomised placebo-controlled trial (ABILITY-1). Ann Rheum Dis. 2012 Jul 7. [Epub ahead of print]
• 32 Song IH. 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 randomised controlled trial. Ann Rheum Dis 2011; 70 (04) 590-596.