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Aktuelle Rheumatologie 2013; 38(02): 92-96
DOI: 10.1055/s-0032-1327617
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Das Konzept der nicht-röntgenologischen axialen Spondyloarthritis

The Concept of Non-Radiographic Axial Spondyloarthritis
U. Kiltz
1   Rheumazentrum Ruhrgebiet, Rheumatologie, Herne
,
X. Baraliakos
1   Rheumazentrum Ruhrgebiet, Rheumatologie, Herne
,
J. Braun
2   Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2013 (online)

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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 nicht-röntgenologischen Form, bei der definitionsgemäß keine derartigen Veränderungen vorliegen. In diesem Übersichtsartikel werden neben den klinischen Charakteristika vor allem die Diagnostik und Therapie der axialen SpA inklusive der nicht-röntgenologischen axialen SpA im Vergleich zur klassischen AS dargestellt.

Abstract

The characteristic features of spondyloarthritis are inflammation of the axial skeleton (sacroiliitis, spondylitis) and inflammation of peripheral joints (arthritis) and entheses (enthesitis). According to the leading clinical symptom, SpA can be differentiated in either a predominant axial or a peripheral form. Axial SpA is further subdivided in the classical ankylosing spondylitis and non-radiographic axial SpA (nr-axSpA). These subsets are differentiated by the presence or absence of structural changes on conventional X-rays of the sacroiliac joints. Here we describe the clinical symptoms, the diagnosis and therapy for patients with axial SpA including patients with nr-axSpA.

Schlüsselwörter

Spondyloarthritis - Management - Empfehlungen

Key words

spondyloarthritis - management - recommendations
 

  • Literatur

  • 1 Rudwaleit M, van der Heijde D, Landewè 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
    CrossrefPubMedGoogle Scholar
  • 2 Rudwaleit M, van der Heijde D, Landewè R et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70: 25-31
    CrossrefPubMedGoogle Scholar
  • 3 Braun J, Baraliakos X. Imaging of axial spondyloarthritisincluding ankylosing spondylitis. Ann Rheum Dis 2011; 70: i97-i102
    CrossrefPubMedGoogle Scholar
  • 4 Braun J, Inman R. Clinical significance of inflammatory back pain for diagnosis and screening of patients with axial spondyloarthrits. Ann Rheum Dis 2010; 69: 1264-1268
    CrossrefPubMedGoogle Scholar
  • 5 Baraliakos X, Lisitng J, Rudwaliet M et al. Development of radiographic scoring tool for ankylosing spondylitis only based on bone formation: addition of the thoracis spine improves sensitivity to change. Arthritis Rheum 2009; 61: 764-771
    CrossrefPubMedGoogle Scholar
  • 6 VanderCryussen 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
    CrossrefPubMedGoogle Scholar
  • 7 Rudwaleit M, Haibel H, Baraliakos X et al. The early disease stage in spondyloarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum 2009; 60: 717-727
    CrossrefPubMedGoogle Scholar
  • 8 Dougados M, d’Agostino MA, Benessiano J 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: 598-603
    CrossrefPubMedGoogle Scholar
  • 9 Kiltz U, Baraliakos X, Karakostas P et al. Patients with with non-radiographic axial spondyloarthritis differ from patients with ankylosing spondylitis in several aspects. Arthritis Care Res 2012; 64: 1415-1422
    CrossrefPubMedGoogle Scholar
  • 10 Kiltz U, Baraliakos X, Karakostas P 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
    CrossrefPubMedGoogle Scholar
  • 11 Peters M, van Eijk I, Smulders Y et al. Signs of Accelerated Preclinical Atherosclerosis in Patients with Ankylosing Spondylitis. J Rheumatol 2010; 37: 161-166
    CrossrefPubMedGoogle Scholar
  • 12 Vosse D, Landewé R, van der Heijde D et al. Ankylosing Spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum 2009; 68: 1839-1842
    CrossrefPubMedGoogle Scholar
  • 13 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
    PubMedGoogle Scholar
  • 14 Feldtkeller E, Khan MA, van der Heijde D et al. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 2003; 23: 61-68
    CrossrefPubMedGoogle Scholar
  • 15 Doran M, Brophy S, Mackay K et al. Predictors of Longterm Outcome in Ankylosing Spondylitis. J Rheumatol 2003; 30: 316-320
    PubMedGoogle Scholar
  • 16 Ward MM. Predictors of the progression of functional disability in patients with ankylosing spondylitis. J Rheumatol 2002; 29: 1420-1425
    PubMedGoogle Scholar
  • 17 Poddubnyy D, Rudwaleit M, Haibel H et al. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis 2011; 70: 1369-1374
    CrossrefPubMedGoogle Scholar
  • 18 Heuft-Dorenbosch L, Landewe R, Weijers R 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 (92) 98
    PubMedGoogle Scholar
  • 19 Sampaio-Barros P, Bortolutzzo AB, Conde RA et al. Undifferentiated spondyloarthritis: a longterm followup. J Rheumatol 2012; 37: 1195-1199
    PubMedGoogle Scholar
  • 20 Braun J, van den Berg R, Baraliakos X et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011; 70: 896-904
    CrossrefPubMedGoogle Scholar
  • 21 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 spondyloarthritis. Ann Rheum Dis 2011; 70: 905-908
    CrossrefPubMedGoogle Scholar
  • 22 Kiltz U, van der Heijde D, Mielants H et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis: the patient version. Ann Rheum Dis 2009; 68: 1381-1386
    CrossrefPubMedGoogle Scholar
  • 23 Kiltz U, Feldtkeller E, Braun J. Deutsche Patientenversion der Empfehlungen für das Management des Morbus Bechterew gemäß ASAS/EULAR. Z Rheumatol 2010; 69: 171-179
    CrossrefPubMedGoogle Scholar
  • 24 Braun J, Zochling J, Märker-Hermann E et al. Empfehlungen für das Management der ankylosierenden Spondylitis gemäß ASAS/EULAR Evaluation im deutschsprachigen Raum. Z Rheumatol 2006; 65: 728-742
    CrossrefPubMedGoogle Scholar
  • 25 Haibel H. Efficacy of adalimumab in the treatment of axial spondyloarthritis without radiographically defined sacroiliitis: results of a twelve-week randomized, double-blind, placebo-controlled trial followed by an open-label extension up to week fifty-two. Arthritis Rheum 2008; 58: 1981-1991
    CrossrefPubMedGoogle Scholar
  • 26 Barkham N, Keen HI, Coates LC et al. Clinical and imaging efficacy of infliximab in HLA-B27-Positive patients with magnetic resonance imaging-determined early sacroiliitis. Arthritis Rheum Apr 2009; 60 (04) 946-954
    CrossrefPubMedGoogle Scholar
  • 27 Song IH, Herrmann KG, Haibel H 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 randomized controlled trial. Ann Rheum Dis 2011; 70: 590-599
    CrossrefPubMedGoogle Scholar