Skip to main content

Advertisement

SpringerLink
Log in

Spondylitis ankylosans

Zielkriterien der Behandlung

Ankylosing spondylitis

Target treatment criteria

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Die Spondyloarthritiden (SpA) haben verschiedene klinische Charakteristika wie entzündliche Wirbelsäulenbeteiligung, Enthesitis und Uveitis und eine zumindest partiell gemeinsame erbliche Komponente in Form der starken Assoziation mit HLA B27. Neben dem wichtigsten und häufigsten Subtyp, der Spondylitis ankylosans (AS), werden 4 weitere Subgruppen zu den SpA gerechnet.

Die derzeit verfügbaren und häufig verwendeten Outcome-Parameter bzw. Zielkriterien in der Therapie der AS werden im vorliegenden Artikel dargestellt. Für potenzielle Zielgrößen in der Behandlung der AS gibt es verschiedene Bereiche. Unter dem Begriff Krankheitsaktivität werden meist verschiedene Aspekte einer entzündlich rheumatischen Erkrankung zusammengefasst. Für die Patienten sind meist die Schmerzen von größter Bedeutung, aber auch die Morgensteifigkeit kann sehr beeinträchtigend sein. Bei AS-Patienten kommen Einschränkungen in der Beweglichkeit der Wirbelsäule und der Funktion hinzu, die zum einen durch die Entzündungsaktivität und zum anderen durch knöcherne strukturelle Veränderungen bedingt sind. Im Sinne der internationalen Klassifikation für Funktion (ICF) betreffen letztere in erster Linie die Struktur des Achsenskeletts, vor allem der Wirbelsäule mit Wirbelkörpern, Wirbelgelenken, Bandscheiben, Sehnenansätzen und Bändern.

Abstract

The spondyloarthritides (SpA) have various clinical signs and symptoms in common: spinal inflammation, enthesitis, uveitis, and an at least partial common genetic factor such as the association with HLA B27. In addition to ankylosing spondylitis (AS), the most prevalent and important subtype, there are four other subtypes.

The currently available and frequently used outcome parameters in the therapy of AS are discussed in this article. There are different areas for the potential aims of therapy in AS. The term disease activity usually covers the various aspects of a systemic inflammatory rheumatic disease. Pain is what usually matters most for patients but also morning stiffness can be quite disabling. In AS patients, restrictions in spinal mobility and decreased function are also significant, due in part to inflammation and structural changes, respectively. As represented in the international classification of function (ICF) this mainly relates to the structure of the axial skeleton, the spinal column and the vertebral bodies, vertebral joints, discs, attachments of ligaments to bone and tendons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369:1379–1390

    Article  PubMed  Google Scholar 

  2. Rudwaleit M, Metter A, Listing J et al (2006) Inflammatory back pain in ankylosing spondylitis - a reassessment of the clinical history for classification and diagnosis. Arthritis Rheum 54:569–578

    Article  PubMed  Google Scholar 

  3. Zink A, Braun J, Listing J, Wollenhaupt J (2000) Disability and handicap in rheumatoid arthritis and ankylosing spondylitis-results from the German rheumatological database. German collaborative arthritis centers. J Rheumatol 27:613–622

    PubMed  CAS  Google Scholar 

  4. Zochling J, van der Heijde D, Burgos-Vargas R et al (2006) ASAS/EULAR recommenddations for the management of ankylosing spondylitis. Ann Rheum Dis 65:442–452

    Article  PubMed  CAS  Google Scholar 

  5. Braun J, Brandt J, Listing J et al (2002) Treatment of active ankylosing spondylitis with infliximab - a double-blind placebo controlled multicenter trial. Lancet 359:1187–1193

    Article  PubMed  CAS  Google Scholar 

  6. Haibel H, Rudwaleit M, Listing J et al (2008) Efficacy of adalimumab in the treatment of axial spondylarthritis 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 58:1981–1991

    Article  PubMed  CAS  Google Scholar 

  7. Davis JC, van der Heijde DM, Braun J et al (2008) Efficacy and safety of up to 192 weeks of etanercept therapy in patients with ankylosing spondylitis. Ann Rheum Dis 67:346–352

    Article  PubMed  CAS  Google Scholar 

  8. Braun J, Baraliakos X, Listing J et al (2008) Persistent clinical efficacy and safety of anti-TNF{alpha} therapy with infliximab in patients with ankylosing spondylitis over 5 years - evidence for different types of response. Ann Rheum Dis 67:340–345

    Article  PubMed  CAS  Google Scholar 

  9. Rudwaleit M, Baraliakos X, Listing J et al (2005) Magnetic resonance imaging of the spine and the sacroiliac joints in ankylosing spondylitis before and during therapy with etanercept. Ann Rheum Dis 64:1305–1310

    Article  PubMed  CAS  Google Scholar 

  10. Braun J, Landewe R, Hermann KG et al (2006) Major reduction in spinal inflammation in patients with ankylosing spondylitis after treatment with infliximab: Results of a multicenter, randomized, double-blind, placebo-controlled magnetic resonance imaging study. Arthritis Rheum 54:1646–1652

    Article  PubMed  CAS  Google Scholar 

  11. Lambert RG, Salonen D, Rahman P et al (2007) Adalimumab significantly reduces both spinal and sacroiliac joint inflammation in patients with ankylosing spondylitis: a multicenter, randomized, double-blind, placebo-controlled study. Arthritis Rheum 56:4005–4014

    Article  PubMed  CAS  Google Scholar 

  12. Baraliakos X, Listing J, Brandt J et al (2007) Radiographic progression in patients with ankylosing spondylitis after 4 yrs of treatment with the anti-TNF-antibody infliximab. Rheumatology (Oxford) 46:1450–1453

    Google Scholar 

  13. van der Heijde D, Landewé R, Einstein S et al (2008) Radiographic progression of ankylosing spondylitis after up to two years of treatment with etanercept. Arthritis Rheum 58:1324–1331

    Article  Google Scholar 

  14. van der Heijde D, Landewé R, Baraliakos X et al (2008) Radiographic findings following two years of infliximab therapy in patients with ankylosing spondylitis. Arthritis Rheum 58:3063–3070

    Article  Google Scholar 

  15. Braun J, Davis J, Dougados M et al (2006) First update of the international ASAS consensus statement for the use of Anti-TNF agents in patients with Ankylosing Spondylitis. Ann Rheum Dis 65:316–320

    Article  PubMed  CAS  Google Scholar 

  16. Braun J, McHugh N, Singh A et al (2007) Improvement in patient-reported outcomes for patients with ankylosing spondylitis treated with etanercept 50 mg once-weekly and 25 mg twice-weekly. Rheumatology (Oxford) 46:999–1004

    Google Scholar 

  17. Davis JC Jr, Revicki D, van der Heijde DM et al (2007) Health-related quality of life outcomes in patients with active ankylosing spondylitis treated with adalimumab: results from a randomized controlled study. Arthritis Rheum 57:1050–1057

    Article  PubMed  Google Scholar 

  18. van der Heijde D, Han C, DeVlam K et al (2006) Infliximab improves productivity and reduces workday loss in patients with ankylosing spondylitis: results from a randomized, placebo-controlled trial. Arthritis Rheum 55:569–574

    Article  Google Scholar 

  19. Wanders A, Landewé R, Dougados M et al (2005) Association between radiographic damage of the spine and spinal mobility for individual patients with ankylosing spondylitis: can assessment of spinal mobility be a proxy for radiographic evaluation? Ann Rheum Dis 64:988–994

    Article  PubMed  CAS  Google Scholar 

  20. Landewé R, Dougados M, Mielants H et al (2008) Physical function in ankylosing spondylitis is independently determined by both disease activity and radiographic damage of the spine. Ann Rheum Dis [Epub ahead of print]

  21. van Echteld I, Cieza A, Boonen A et al (2006) Identification of the most common problems by patients with ankylosing spondylitis using the international classification of functioning, disability and health. J Rheumatol 33:2475–2483

    Google Scholar 

  22. Tubach F, Pham T, Skomsvoll JF et al (2006) Stability of the patient acceptable symptomatic state over time in outcome criteria in ankylosing spondylitis. Arthritis Rheum 55:960–963

    Article  PubMed  Google Scholar 

  23. Katz PP (2003) Introduction to special patient outcomes in rheumatology. Arthritis Care Res 49 (5S):S1–S4

    Article  Google Scholar 

  24. 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

    PubMed  CAS  Google Scholar 

  25. Lukas C, Landewé R, Sieper J et al (2008) Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis [Epub ahead of print]

  26. Heuft-Dorenbosch L, Spoorenberg A, van Tubergen A et al (2003) Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 62:127–132

    Article  PubMed  CAS  Google Scholar 

  27. Calin A, Garrett S, Whitelock H et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285

    PubMed  CAS  Google Scholar 

  28. van der Heijde D, Landewé R, Feldtkeller E (2008) Proposal of a linear definition of the Bath Ankylosing Spondylitis Metrology Index (BASMI) and comparison with the 2-step and 10-step definitions. Ann Rheum Dis 67:489–493

    Google Scholar 

  29. 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

    Article  PubMed  CAS  Google Scholar 

  30. Wanders AJ, Landewé 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 

  31. Van Tubergen A, Debats I, Ryser L et al (2002) Use of a numerical rating scale as an answer modality in ankylosing spondylitis-specific questionnaires. Arthritis Rheum 47:242–248

    Article  Google Scholar 

  32. 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  PubMed  CAS  Google Scholar 

  33. Brandt J, Listing J, Sieper J et al (2004) Development and preselection of criteria for short-term improvement after anti-TNF{alpha} therapy in ankylosing spondylitis. Ann Rheum Dis 64:1438–1444

    Article  Google Scholar 

  34. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–480

    Article  PubMed  Google Scholar 

  35. McHorney CA, Ware JE Jr, Raczek AD (1993) The MOS 36-item short-form health survey (SF-36). II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31:247–263

    Article  PubMed  CAS  Google Scholar 

  36. 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  PubMed  CAS  Google Scholar 

  37. Hurst NP, Kind P, Ruta D et al (1997) Measuring health-related quality of life in rheumatoid arthritis: validity responsivness and reliabilty of EuroQol (EQ-5D). Br J Rheumatol 36:551–559

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Rheumazentrum Ruhrgebiet, Landgrafenstr.15, 44652, Herne, Deutschland

    J. Braun

  2. Rheumatologie, Charité-Universitätsmedizin, Berlin, Deutschland

    J. Sieper

Authors
  1. J. Braun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Sieper
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Braun.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Braun, J., Sieper, J. Spondylitis ankylosans. Z. Rheumatol. 68, 30–36 (2009). https://doi.org/10.1007/s00393-008-0361-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-008-0361-y

Schlüsselwörter

Keywords

Search

Navigation