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Outcome-Parameter bei der ankylosierenden Spondylitis

Outcome parameters in ankylosing spondylitis

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Zusammenfassung

Die ankylosierende Spondylitis (AS), Prototyp der Spondyloarthritiden (SpA), ist eine häufige entzündlich rheumatische Erkrankung. In den letzten Jahren sind Outcome-Parameter entwickelt worden, die Ausmaß und Aktivität der Erkrankung erfassen. Zu diesen gehören „Bath AS Disease Activity Index“ (BASDAI), „Bath AS Functional Index“ (BASFI), „Bath AS Metrology Index“ (BASMI), numerische Rating-Skalen zum allgemeinen Schmerz, nächtlichen Schmerz, zur allgemeinen Krankheitsaktivität, zum allgemeinen Arzturteil sowie verschiedene Lebensqualitätsfragebögen wie „Short Form 36“ (SF-36) oder „Euroquol 5 Dimensions“ (EQ-5D) und als AS- spezifischer Fragebogen der „ASQuol“. Diese bilden die Grundlage für die Durchführung klinischer Studien. Die ASessments-in-Ankylosing-Spondylitis- (ASAS-) Improvement-Kriterien sind entwickelt worden, um den Kurzzeiteffekt von nichtsteroidalen Antirheumatika (NSAR) zu beurteilen, und weiterentwickelt worden, um die hocheffektiven Biologikatherapien einzuschätzen. Zur Beurteilung der Röntgenbilder der Sakroiliakalgelenke (SIG) im Verlauf werden die radiologischen Kriterien, die den modifizierten New-York-Kriterien zugrunde liegen, genutzt. Für die Wirbelsäule ist der Bath AS Radiology Index (BASRI) eher für den klinischen Alltag sinnvoll, während der modifizierte Stokes AS Spinal Score (mSASSS) sensitiver zur Verlaufsbeobachtung bei klinischen Studien ist. Weitere Scores zur Beurteilung von MRT-Aufnahmen der Wirbelsäule und der SIG werden derzeit entwickelt. Insgesamt konnte mittels dieser neuen Outcome-Parameter die hohe Wirksamkeit der TNF-α-Blocker belegt werden. Es konnte aber auch gezeigt werden, dass konventionelle krankheitsmodifizierende Antirheumatika bei der axialen Form der SpA nicht wirksam sind.

Abstract

Ankylosing spondylitis (AS) is a frequent inflammatory rheumatic disease and prototype of the Spondyloarthitides (SpA). During the last years outcome parameters have been developed to evaluate different aspects of the disease. Among these are the Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), numeric rating scales for general pain, night pain, patients and physicians global assessment, as well as questionnaires to evaluate quality of life as the short Form (SF)- 36, Euroquol 5 Dimensions (EQ-5D), or the AS specific the ASQuol. These outcome parameters are the basis to conduct clinical trials. The ASessements in AS (ASAS) improvement criteria were developed to evaluate the short term efficacy of Non-Steroidal Antirheumatic Drugs (NSAIDs) and adjusted for the measurement of the high efficacy of the TNF-alpha blocking agents. To examine the x-rays of sacroiliac joints (SIG), the radiological criteria as part of the modified New York criteria are mostly used. For the x-rays of the spine the Bath AS Radiology Index (BASRI) is valuable in daily practice, but the modified Stokes AS Spine Score (mSASSS) is more sensitive for clinical trials. To examine Magnetic Resonance Images (MRI) of SIG and spine also scores are currently developed. Altogether, using the new outcome parameters it was possible to demonstrate the strikingly high efficacy of the TNF-alpha blocking agents. However, it could also be shown that conventional disease modifying antirheumatic drugs (DMARDs) are not effective in the treatment of the axial forms of SpA.

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Literatur

  1. Anderson JJ, Baron G, van der Heijde D et al. (2001) Ankylosing spondylitis assessment group preliminary definition of short-term improvement in ankylosing spondylitis. Arthritis Rheum 44:1876–1886

    Article  CAS  PubMed  Google Scholar 

  2. Baraliakos X, Listing J, Rudwaleit M et al. (2005) Radiographic progression in patients with ankylosing spondylitis after 2 years of treatment with the tumour necrosis factor alpha antibody infliximab. Ann Rheum Dis 64:1462–1466 (Epub 2005 Mar 18)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Brandt J, Khariouzov A, Listing J et al. (2003 a) Six-month results of a double-blind, placebo-controlled trial of etanercept treatment in patients with active ankylosing spondylitis. Arthritis Rheum 48:1667–1675

    Article  CAS  PubMed  Google Scholar 

  4. Brandt J, Westhoff G, Rudwaleit M et al. (2003 b) Adaption and validation of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for use in Germany. Z Rheumatol 62:264–273

    CAS  PubMed  Google Scholar 

  5. Brandt J, Listing J, Sieper J et al. (2004) Development and preselection of criteria for short term improvement after anti-TNF alpha treatment in ankylosing spondylitis. Ann Rheum Dis 63:1438–1444 (Epub 2004 Mar 25)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Braun J, Bollow M, Remlinger G et al. (1998) Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 41:58–67

    Article  CAS  PubMed  Google Scholar 

  7. Braun J, Brandt J, Listing J et al. (2002) Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet 359:1187–1193

    Article  CAS  PubMed  Google Scholar 

  8. Braun J, Baraliakos X, Golder W et al. (2003) Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system. Arthritis Rheum 48:1126–1136

    Article  CAS  PubMed  Google Scholar 

  9. Bullinger M, Kirchberger I (1998) SF-36 Fragebogen zum Gesundheitszustand. Hogrefe, Göttingen

  10. Calin A, Garrett S, Jenkinson T et al. (1994) A new approach to defining functional ability in ankylosing spondylitis. The Bath AS functional index. J Rheumatol 21:2286–2291

    PubMed  Google Scholar 

  11. Creemers MC, Franssen MJ, van’t Hof MA et al. (2005) Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis 64:127–129 (Epub 2004 Mar 29)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Davis JC Jr, Van Der Heijde D, Braun J et al., Enbrel Ankylosing Spondylitis Study Group (2003) Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomized, controlled trial. Arthritis Rheum 48:3230–3236

    Article  CAS  PubMed  Google Scholar 

  13. Doward LC, Spoorenberg A, Cook SA et al. (2003) Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis 62:20–26

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Garrett S, Jenkinson T, Kennedy LG et al. (1994) A new approach to defining disease status in ankylosing spondylitis: The Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291

    CAS  PubMed  Google Scholar 

  15. Greiner W, Claes C, Busschbach JJ, Graf von der Schulenburg JM (2004) Validating the EQ-5D with time trade off for the German population. Eur J Health Econ Dec 22 (Epus Aheao of Print)

  16. Haibel H, Rudwaleit M, Listing J, Sieper J (2004) Open label trial of anakinra in active ankylosing spondylitis over 24 weeks. Ann Rheum Dis 64:296-298 (Epub 2004 Jun 18)

    Article  PubMed  PubMed Central  Google Scholar 

  17. Haibel H, Rudwaleit M, Braun J, Sieper J (2005) Six months open label trial of leflunomide in active ankylosing spondylitis. Ann Rheum Dis 64:124–126

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Hurst NP, Kind P, Ruta D, Hunter M, Stubbings A (1997) Measuring health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol 36:551–559

    Article  CAS  PubMed  Google Scholar 

  19. Jenkinson TR, Mallorie PA, Whitelock HC et al. (1994) Defining spinal mobility in ankylosing spondylitis. The Bath AS metrology index. J Rheumatol 21:1694–1698

    CAS  PubMed  Google Scholar 

  20. Jones SD, Porter J, Garrett SL et al. (1995) A new scoring system for the Bath Ankylosing Spondylitis Metrology Index (BASMI). J Rheumatol 22:1609

    CAS  PubMed  Google Scholar 

  21. Jones SD, Steiner A, Garrett SL, Calin A (1996) The Bath Ankylosing Spondylitis Patient Global Score (BAS-G). Br J Rheumatol 35:66–71

    Article  CAS  PubMed  Google Scholar 

  22. MacKay K, Mack C, Brophy S, Calin A (1998) The Bath Ankylosing Spondylitis Radiology Index (BASRI): a new, validated approach to disease assessment. Arthritis Rheum 41:2263–2270

    Article  CAS  PubMed  Google Scholar 

  23. Ruof J, Sangha O, Stucki G (1999) Evaluation of a German version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and Dougados Functional Index (D-FI). Z Rheumatol 58:218–225

    Article  CAS  PubMed  Google Scholar 

  24. Van der Heijde D, Bellamy N, Calin A et al. (1997) Preliminary core sets for endpoints in ankylosing spondylitis. Assessments in Ankylosing Spondylitis Working Group. J Rheumatol 24:2225–2229

    CAS  PubMed  Google Scholar 

  25. Van der Heijde D, Landewe R, Spoorenberg A et al. (2003) Can a historical cohort of patients with ankylosing spondylitis containing data of 2 year radiographic progression serve as a control group to assess inhibition of structural damage by TNF-blockers? Arthritis Rheum 48 [Suppl 9]: S441

    Google Scholar 

  26. Van der Heijde D, Baraf HS, Ramos-Remus C et al. (2005 a) Evaluation of the efficacy of etoricoxib in ankylosing spondylitis: results of a fifty-two-week, randomized, controlled study. Arthritis Rheum 52:1205–1215

    Article  CAS  PubMed  Google Scholar 

  27. Van der Heijde D, Dijkmans B, Geusens P et al., Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy Study Group (2005 b) Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT). Arthritis Rheum 52:582–591

    Article  Google Scholar 

  28. Van der Heijde D, Dougados M, Davis J et al., Assessment in Ankylosing Spondylitis International Working Group (2005 c) Assessment in Ankylosing Spondylitis International Working Group/Spondylitis Association of America recommendations for conducting clinical trials in ankylosing spondylitis. Arthritis Rheum 52:386–394

    Article  PubMed  Google Scholar 

  29. Van der Heijde D, Landewe R, van der Linden S (2005 d) How should treatment effect on spinal radiographic progression in patients with ankylosing spondylitis be measured? Arthritis Rheum 52:1979–1985

    Article  CAS  PubMed  Google Scholar 

  30. Van der Linden, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368

    Article  CAS  PubMed  Google Scholar 

  31. Wanders AJ, Landewe RB, Spoorenberg A et al. (2004) What is the most appropriate radiologic scoring method for ankylosing spondylitis? A comparison of the available methods based on the Outcome Measures in Rheumatology Clinical Trials filter. Arthritis Rheum 50:2622–2632

    Article  PubMed  Google Scholar 

  32. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Rheumatologie, Charité - Campus Benjamin Franklin, Berlin

    M. Rudwaleit & J. Sieper

  2. Rheumatologie, Charité - Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin

    H. Haibel

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  1. H. Haibel
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  2. M. Rudwaleit
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  3. J. Sieper
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Correspondence to H. Haibel.

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Haibel, H., Rudwaleit, M. & Sieper, J. Outcome-Parameter bei der ankylosierenden Spondylitis. Z Rheumatol 65, 131–138 (2006). https://doi.org/10.1007/s00393-006-0038-3

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