Konzept der peripheren Spondyloarthritis: Aktueller Stand und Herausforderungen

Zusammenfassung

Arthritis, Enthesitis und Daktylitis sind die Kardinalsymptome der Klassifikationskriterien der Assessment of SpondyloArthritis International Society (ASAS) der peripheren Spondyloarthritis (pSpA). Die pSpA kann aufgrund des klinischen Erscheinungsbildes und/oder extra-muskuloskelettaler Manifestationen in die zugeordneten Diagnosen reaktive Arthritis (ReA), Psoriasis Arthritis (PsA), chronisch entzündliche Darmerkrankung assoziierte Spondyloarthritis und undifferenzierte SpA unterteilt werden. Daten aus Registern belegen den großen Anteil der pSpA an der Gesamtheit der Spondyloarthritis (SpA) in der rheumatologischen Praxis und dabei die überwiegende Häufigkeit der PsA. Die klinischen Symptome sind sehr variabel, abhängig von einer Überlappung der drei Kardinalsymptome und von der zugrunde liegenden Diagnose. Die ASAS Klassifikationskriterien der pSpA wurden für Forschungszwecke und klinische Studien entwickelt um eine homogene Gruppe bereits diagnostizierter Patienten einzuschließen. Aufgrund unzureichender Sensitivität sind sie nicht für die klinische Diagnose geeignet.

Empfehlungen für das diagnostische Vorgehen schließen die ASAS Kriterien dennoch als Hilfe mit ein, es wird aber auch auf die Classification Criteria of Psoriatic Arthritis für die PsA und die Kriterien der Französischen Gesellschaft für Rheumatologie für die ReA verwiesen. Wirksamkeit und Nebenwirkungen nichtsteroidaler Antirheumatika, oraler oder parenteraler Glukokortikoide, sowie konventioneller synthetischer krankheitsmodifizierender Antirheumatika wurden bei pSpA bisher nicht systematisch untersucht. Die Biologika Adalimumab und Golimumab sind bei Patienten mit pSpA klassifiziert nach den ASAS Kriterien in kontrollierten Studien geprüft, wurde jedoch noch nicht für diese Indikation zugelassen. Die unter pSpA wegen ihrer gemeinsamen Manifestationen zusammengefassten nosologischen Entitäten unterscheiden sich hinsichtlich Prognose, Verlauf und Ansprechen auf Therapien grundlegend. Axiale Symptome (Sakroiliitis in der Bildgebung, entzündlicher Rückenschmerz jemals) sind Teil der ASAS Klassifikationskriterien für die pSpA, weshalb die klinischen Überschneidungen mit der axialen SpA zu einer großen Herausforderung für den Einsatz des binären ASAS Konzeptes in der rheumatologischen Praxis führen.

Abstract

Arthritis, enthesitis and dactylitis are the cardinal symptoms of the Assessment of SpondyloArthritis International Society (ASAS) classification criteria of peripheral spondyloarthritis (pSpA). Based on the clinical presentation and/or extra-musculoskeletal manifestations, pSpA can be subdivided into the associated diagnoses of reactive arthritis (ReA), psoriatic arthritis (PsA), inflammatory bowel disease-associated spondyloarthritis and undifferentiated SpA. Data from registers demonstrate the large proportion of pSpA in the overall of spondyloarthritis (SpA) in rheumatological practice and the predominant frequency of psoriatic arthritis (PsA). The clinical symptoms are very variable, depending on an overlap of the three cardinal symptoms and on the underlying diagnosis. ASAS classification criteria for pSpA were developed for research purposes and clinical studies to include a homogeneous group of already diagnosed patients. They are not suitable for clinical diagnosis due to insufficient sensitivity.

However, recommendations for the diagnostic procedure include the ASAS criteria as an aid, but reference is also made to the Classification Criteria of Psoriatic Arthritis for PsA and the criteria of the French Society of Rheumatology for ReA. The efficacy and side effects of non-steroidal anti-rheumatic drugs, oral or parenteral glucocorticoids, and conventional synthetic disease-modifying anti-rheumatic drugs have not yet been systematically investigated in pSpA. The biologics adalimumab and golimumab have been tested in controlled studies in patients with pSpA classified according to the ASAS criteria, but are not yet approved for this indication. The nosological entities grouped together under pSpA because of their common manifestations differ fundamentally in terms of prognosis, course, and response to therapy. Axial symptoms (sacroiliitis on imaging, inflammatory back pain ever) are part of the ASAS classification criteria for pSpA, which is why the clinical overlap with the axial SpA leads to a major challenge for the application of the binary ASAS concept in rheumatological practice.

Schlüsselwörter

Periphere Spondyloarthritis - Epidemiologie - Diagnose - Therapie - Forschungsbedarf

Keywords

peripheral spondyloarthritis - epidemiology - diagnosis - treatment - research needs

Publication History

Received: 04 February 2025

Accepted: 11 March 2025

Article published online:
27 May 2025

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