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Spondyloarthritiden

Spondyloarthritides

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Zusammenfassung

Die Spondyloarthritiden sind eine durch klinische Symptome und genetische Prädisposition verbundene Gruppe von entzündlich-rheumatischen Erkrankungen, deren wichtigster Subtyp die ankylosierende Spondylitis ist. Die anderen Subtypen sind die Spondyloarthritis bei Psoriasis, nach vorausgehenden Infektionen, in Assoziation mit chronisch-entzündlichen Darmerkrankungen und die undifferenzierte Spondyloarthritis. Die wichtigsten klinischen Symptome sind der entzündliche Rückenschmerz und die periphere, meist asymmetrische Oligoarthritis und die Enthesitis. Die mögliche Beteiligung anderer Organe ist zum Teil typisch, die Häufigkeit bei den Subtypen unterschiedlich: Betroffen sind v. a. die Augen, die Haut und der Darm. Seltener treten Aortenklappenfehler und Herzrhythmusstörungen auf. Der stärkste genetische Faktor ist das MHC-Klasse-Molekül HLA-B27, welches 90% der Patienten mit ankylosierender Spondylitis aufweisen. Die diagnostischen Möglichkeiten für die Früherkennung haben sich in den letzten Jahren verbessert. Die frühe Bestimmung von HLA-B27 und die Magnetresonanztomographie tragen dazu bei. Die konventionelle Radiographie ist aber immer noch der Goldstandard für die Diagnostik. Seit kurzem stehen neue Klassifikationskriterien für die axiale und die periphere Spondyloarthritis zur Verfügung, internationale Empfehlungen für das Management der ankylosierender Spondylitis wurden kürzlich publiziert.

Abstract

Spondyloarthritides are a group of inflammatory rheumatic disorders related by clinical symptoms and genetic predisposition; the most important subtype is ankylosing spondylitis. The other subtypes include psoriatic spondyloarthritis, after preceding infections, in association with chronic inflammatory bowel diseases, and undifferentiated spondyloarthritis. The most significant clinical symptoms are inflammatory back pain and peripheral, usually asymmetric oligoarthritis and enthesitis. The possibility of other organs being involved is typical to some extent and the frequency varies among the subtypes: particularly affected are the eyes, the skin, and the intestines. Less commonly aortic valve defects and arrhythmias occur. The strongest genetic factor is the MHC class I molecule HLA-B27, which is exhibited by 90% of the patients with ankylosing spondylitis. The diagnostic possibilities for early identification have improved in the last few years. Early determination of HLA-B27 and magnetic resonance imaging have contributed to this development. Conventional radiography still represents the gold standard in the diagnostic workup. New criteria for classification of axial and peripheral spondyloarthritis have recently become available and international recommendations for the management of ankylosing spondylitis were recently published.

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Abbreviations

ASAS:

Assessment of SpondyloArthritis international Society

ASDAS:

Ankylosing Spondylitis Disease Activity Score

BASDAI:

Bath Ankylosing Spondylitis Disease Activity Index

BASFI:

Bath Ankylosing Spondylitis Functional Index

CASPAR:

„Classification of psoriatic arthritis“

CRT:

C-reaktives Protein

DMARD:

„Disease modifying antirheumatic drugs“

EULAR:

European League Against Rheumatism

HLA:

Human Leukocyte Antigen

LWS:

Lendenwirbelsäule

MRT:

Magnetresonanztomographie

mSASSS:

Modifizierter Stokes-Spondylitis-ankylosans-Spinal-Score

NSAR:

Nichtsteroidale Antirheumatika

SAPHO:

Synovitis, Akne, Pustolose, Hyperostose, Osteitis

SpA:

Spondyloarthritis

TNF:

Tumornekrosefaktor

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Authors and Affiliations

  1. Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Landgrafenstraße 15, 44652, Herne, Deutschland

    J. Braun

  2. Rheumaklinik Hagen, Evangelisches Krankenhaus Hagen-Haspe GmbH, Hagen, Deutschland

    M. Rudwaleit

  3. Rheumatologie, Universitätsmedizin Charité Berlin, Berlin, Deutschland

    J. Sieper

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Correspondence to J. Braun.

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Braun, J., Rudwaleit, M. & Sieper, J. Spondyloarthritiden. Internist 52, 657–670 (2011). https://doi.org/10.1007/s00108-010-2766-3

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