Subscribe to RSS
DOI: 10.1055/a-1990-6490
Diagnostik und Therapie der ankylosierenden Spondylarthritis – ein Update

Die ankylosierende Spondylarthritis stellt eine häufige rheumatologische Erkrankung dar, die nach wie vor diagnostisch und therapeutisch zahlreiche Herausforderungen bietet. Trotz besserem Verständnis der Pathogenese bleibt die diagnostische Abgrenzung zu den häufigeren unspezifischen Rückenschmerzen schwierig. Therapeutisch haben sich in der medikamentösen Behandlung ebenso wie bei den chirurgischen Verfahren neue Möglichkeiten ergeben. Der Artikel stellt ein Update zur Diagnostik und der Therapie der AS und den Entwicklungen der letzten Jahre dar.
Publication History
Article published online:
11 August 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Burgos-Varga R, Wei JC-C, Rahman MU. et al. The prevalence and clinical characteristics of nonradiographic axial spondyloarthritis among patients with inflammatory back pain in rheumatology practices: a multinational, multicenter study. Arthritis Res Ther 2016; 18: 132 DOI: 10.1186/s13075-016-1027-9.
- 2 Dean LE, Jones GT, MacDonald AG. et al. Global prevalence of ankylosing spondylitis. Rheumatology (Oxford) 2014; 53: 650-657 DOI: 10.1093/rheumatology/ket387.
- 3 Glintborg B, Sørensen IJ, Østergaard M. et al. Ankylosing spondylitis versus nonradiographic axial spondyloarthritis: comparison of tumor necrosis factor inhibitor effectiveness and effect of HLA-B27 Status. An Observational Cohort Study from the Nationwide DANBIO Registry. J Rheumatol 2017; 44: 59-69 DOI: 10.3899/jrheum.160958.
- 4 Schön MP. Adaptive and Innate immunity in psoriasis and other inflammatory disorders. Front Immunol 2019; 10: 1764 DOI: 10.3389/fimmu.2019.01764.
- 5 Kebapcilar L, Bilgir O, Alacacioglu A. et al. Impaired hypothalamo-pituitary-adrenal axis in patients with ankylosing spondylitis. J Endocrinol Invest 2010; 33: 42-47 DOI: 10.1007/BF03346548.
- 6 Faham M, Carlton V, Moorhead M. et al. Discovery of T cell receptor β motifs specific to HLA-B27-positive ankylosing spondylitis by deep repertoire sequence analysis. Arthritis Rheumatol 2017; 69: 774-784 DOI: 10.1002/art.40028.
- 7 Colbert RA, Tran TM, Layh-Schmitt G. HLA-B27 misfolding and ankylosing spondylitis. Mol Immunol 2014; 57: 44-51 DOI: 10.1016/j.molimm.2013.07.013.
- 8 Zhu W, He X, Cheng K. et al. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res 2019; 7: 22 DOI: 10.1038/s41413-019-0057-8.
- 9 Chen H-A, Chen C-H, Liao H-T. et al. Clinical, functional, and radiographic differences among juvenile-onset, adult-onset, and late-onset ankylosing spondylitis. J Rheumatol 2012; 39: 1013-1018 DOI: 10.3899/jrheum.111031.
- 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 DOI: 10.1002/art.21619.
- 11 Briot K, Etcheto A, Miceli-Richard C. et al. Bone loss in patients with early inflammatory back pain suggestive of spondyloarthritis: results from the prospective DESIR cohort. Rheumatology (Oxford) 2016; 55: 335-342 DOI: 10.1093/rheumatology/kev332.
- 12 Vander Cruyssen B, Ribbens C, Boonen A. et al. The epidemiology of ankylosing spondylitis and the commencement of anti-TNF therapy in daily rheumatology practice. Ann Rheum Dis 2007; 66: 1072-1077 DOI: 10.1136/ard.2006.064543.
- 13 Wenker KJ, Quint JM. Ankylosing Spondylitis. Treasure Island (FL): StatPearls; 2020
- 14 Chenot J-F, Greitemann B, Kladny B. et al. Non-specific low back pain. Dtsch Arztebl Int 2017; 114: 883-890 DOI: 10.3238/arztebl.2017.0883.
- 15 Calin A, Kaye B, Sternberg M. et al. The prevalence and nature of back pain in an industrial complex: a questionnaire and radiographic and HLA analysis. Spine (Phila Pa 1976) 1980; 5: 201-205 DOI: 10.1097/00007632-198003000-00016.
- 16 Braun J, Mosch T, Fischer I. et al. Identifikation von Patienten mit axialer Spondyloarthritis in der Primärversorgung (AWARE-Studie). Z Rheumatol 2019; 78: 568-576 DOI: 10.1007/s00393-018-0550-2.
- 17 Schokowski U. „Den Bechterew übersehe ich nicht – ich mache mit“. Orthop Unfallchir Mitt Nachrichten 2012; 1: 686-687 DOI: 10.1055/s-0033-1348294.
- 18 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: 361-368 DOI: 10.1002/art.1780270401.
- 19 Rudwaleit M, van der Heijde D, Landewé R. 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: 777-783 DOI: 10.1136/ard.2009.108233.
- 20 Dale K, Vinje O. Radiography of the spine and sacro-iliac joints in ankylosing spondylitis and psoriasis. Acta Radiol Diagn (Stockh) 1985; 26: 145-159 DOI: 10.1177/028418518502600205.
- 21 Dihlmann W. Röntgendiagnostik der Sakroiliakalgelenke und ihrer nahen Umgebung. 2. Aufl. Stuttgart: Thieme; 1978
- 23 van Gaalen FA, Bakker PAC, Hooge Mde. et al. Assessment of sacroiliitis by radiographs and MRI: where are we now?. Curr Opin Rheumatol 2014; 26: 384-388 DOI: 10.1097/BOR.0000000000000066.
- 24 Poddubnyy D, Gaydukova I, Hermann K-G. et al. Magnetic resonance imaging compared to conventional radiographs for detection of chronic structural changes in sacroiliac joints in axial spondyloarthritis. J Rheumatol 2013; 40: 1557-1565 DOI: 10.3899/jrheum.130141.
- 25 Ez-Zaitouni Z, Bakker PA, van Lunteren M. et al. The yield of a positive MRI of the spine as imaging criterion in the ASAS classification criteria for axial spondyloarthritis: results from the SPACE and DESIR cohorts. Ann Rheum Dis 2017; 76: 1731-1736 DOI: 10.1136/annrheumdis-2017-211486.
- 26 Reiser M, Kuhn F-P. Debus J. Radiologie. Stuttgart: Thieme; 2017
- 27 Akgul O, Bodur H, Ataman S. et al. Clinical performance of ASAS Health Index in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: real-world evidence from Multicenter Nationwide Registry. Rheumatol Int 2020; 40: 1793-1801 DOI: 10.1007/s00296-020-04680-8.
- 28 de Jong H, Paramarta JE, de Winter J. et al. Differences between females and males in axial spondyloarthritis: data from a reallife cross-sectional cohort. Scand J Rheumatol 2020; 49: 28-32 DOI: 10.1080/03009742.2019.1627410.
- 29 Navarro-Compán V. An update on diagnosis and classification of axial spondyloarthritis. Curr Rheumatol Rep 2019; 21: 39 DOI: 10.1007/s11926-019-0838-5.
- 30 Regnaux J-P, Davergne T, Palazzo C. et al. Exercise programmes for ankylosing spondylitis. Cochrane Database Syst Rev 2019; 10: CD011321 DOI: 10.1002/14651858.CD011321.pub2.
- 31 Sharan D, Rajkumar JS. Physiotherapy for ankylosing spondylitis: systematic review and a proposed rehabilitation protocol. Curr Rheumatol Rev 2017; 13: 121-125 DOI: 10.2174/1573397112666161025112750.
- 32 Turan Y, Bayraktar K, Kahvecioglu F. et al. Is magnetotherapy applied to bilateral hips effective in ankylosing spondylitis patients? A randomized, double-blind, controlled study. Rheumatol Int 2014; 34: 357-365 DOI: 10.1007/s00296-013-2941-7.
- 33 Şilte Karamanlioğlu D, Aktas I, Ozkan FU. et al. Effectiveness of ultrasound treatment applied with exercise therapy on patients with ankylosing spondylitis: a double-blind, randomized, placebo-controlled trial. Rheumatol Int 2016; 36: 653-661 DOI: 10.1007/s00296-016-3441-3.
- 34 Balazcs E, Sieper J, Bickham K. et al. A randomized, clinical trial to assess the relative efficacy and tolerability of two doses of etoricoxib versus naproxen in patients with ankylosing spondylitis. BMC Musculoskelet Disord 2016; 17: 426 DOI: 10.1186/s12891-016-1275-5.
- 35 van der Heijde D, Sieper J, Maksymowych WP. 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: 905-908 DOI: 10.1136/ard.2011.151563.
- 36 Tański W, Świątoniowska-Lonc N, Dudek K. et al. Benefit of biological drugs for quality of life in patients with ankylosing spondylitis: a systematic review and meta-analysis of clinical trials. Adv Exp Med Biol 2020; DOI: 10.1007/5584_2020_611.
- 37 de Vries MK, van Eijk IC, van der Horst-Bruinsma IE. et al. Erythrocyte sedimentation rate, C-reactive protein level, and serum amyloid a protein for patient selection and monitoring of antitumor necrosis factor treatment in ankylosing spondylitis. Arthritis Rheum 2009; 61: 1484-1490 DOI: 10.1002/art.24838.
- 38 Arends S, Brouwer E, van der Veer E. et al. Baseline predictors of response and discontinuation of tumor necrosis factor-alpha blocking therapy in ankylosing spondylitis: a prospective longitudinal observational cohort study. Arthritis Res Ther 2011; 13: R94 DOI: 10.1186/ar3369.
- 39 Baraliakos X, Listing J, Brandt J. et al. Clinical response to discontinuation of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab. Arthritis Res Ther 2005; 7: R439-R444 DOI: 10.1186/ar1693.
- 40 Toussirot E. Pharmacological management of axial spondyloarthritis in adults. Expert Opin Pharmacother 2019; 20: 1483-1491 DOI: 10.1080/14656566.2019.1617853.
- 41 Mease P. Emerging immunomodulatory therapies and new treatment paradigms for axial spondyloarthritis. Curr Rheumatol Rep 2019; 21: 35 DOI: 10.1007/s11926-019-0830-0.
- 42 Abdolmohammadi K, Pakdel FD, Aghaei H. et al. Ankylosing spondylitis and mesenchymal stromal/stem cell therapy: a new therapeutic approach. Biomed Pharmacother 2019; 109: 1196-1205 DOI: 10.1016/j.biopha.2018.10.137.
- 43 Rehart S, Petak N. Moderne rheumatische Basistherapie perioperativ. Akt Rheumatol 2007; 32: 74-77 DOI: 10.1055/s-2007-963081.
- 44 Hempfing A, Zenner J, Ferraris L. et al. Wiederherstellung der sagittalen Balance bei der Versorgung thorakaler und lumbaler Wirbelkörperfrakturen. Orthopade 2011; 40: 690 DOI: 10.1007/s00132-011-1796-4.
- 45 McLain RF. Functional outcomes after surgery for spinal fractures: return to work and activity. Spine (Phila Pa 1976) 2004; 29: 470-477 discussion Z6 DOI: 10.1097/01.BRS.0000092373.57039.FC.
- 46 Reinhold M, Knop C, Kneitz C. et al. Spine fractures in ankylosing diseases: recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018; 8: 56S-68S DOI: 10.1177/2192568217736268.
- 47 Tavolaro C, Ghaffar S, Zhou H. et al. Is routine MRI of the spine necessary in trauma patients with ankylosing spinal disorders or is a CT scan sufficient?. Spine J 2019; 19: 1331-1339 DOI: 10.1016/j.spinee.2019.03.004.
- 48 Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J 2009; 18: 145-156 DOI: 10.1007/s00586-008-0764-0.