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Evidenzbasierte Empfehlung zur Diagnostik und Therapie der axialen Spondyloarthritis

S3-Leitlinie der Deutschen Gesellschaft für Rheumatologie (DGRh) in Kooperation mit der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF)

Evidence-based recommendations on diagnostics and therapy of axial spondyloarthritis

S3 guidelines of the German Society of Rheumatology (DGRh) in cooperation with the Association of the Scientific Medical Societies in Germany (AWMF)

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Zusammenfassung

Der klinische Verlauf der axialen Spondyloarthritis (axSpA) ist variabel und durch chronische Rückenschmerzen und extraspinale Manifestationen wie asymmetrische Oligoarthritis, Enthesitis und Daktylitis gekennzeichnet. Nicht wenige Patienten haben auch extraartikuläre Manifestationen an Augen (anteriore Uveitis), Haut (Psoriasis) oder Darm (chronisch entzündliche Darmerkrankungen). Durch die Heterogenität des klinischen Bildes und die Konzentration auf röntgenologisch sichtbare strukturelle Veränderungen in den Sakroiliakalgelenken ist es zu einer zum Teil erheblichen Verzögerung von mehreren Jahren bei der Diagnosestellung gekommen. Ein wichtiger Schritt in Richtung einer verbesserten Früherkennung waren die 2009 publizierten Assessment of SpondyloArthritis International Society (ASAS)-Klassifikationskriterien für axSpA, die neben der Chronizität der initial meist tief sitzenden Rückenschmerzen bei noch relativ jungen Menschen sowohl die Bedeutung der Magnetresonanztomographie als auch die Bestimmung von HLA-B27 in frühen Phasen der Erkrankung betonen. Um die Grundlagen für eine effektive und frühzeitige Therapie der betroffenen Patienten zu gewährleisten, ist dann im Jahr 2014 auf Initiative der Deutschen Gesellschaft für Rheumatologie (DGRh) eine S3-Leitlinie „Axiale Spondyloarthritis inklusive Morbus Bechterew und Frühformen“ unter Mitwirkungen vieler anderer Fachgesellschaften erstellt worden. Dieser Beitrag gibt einen Überblick über den Inhalt der S3-Leitlinie zur axSpA.

Abstract

The clinical course of axial spondyloarthritis (SpA) is variable and characterized by chronic back pain and extraspinal manifestations, such as asymmetrical arthritis, dactylitis and enthesitis. Extra-articular manifestations in the eyes (anterior uveitis), skin (psoriasis) and intestines (chronic inflammatory bowel disease) are also frequent manifestations in patients with SpA. Due to the heterogeneity of disease manifestations and the partial concentration on structural alterations in the sacroiliac joints visible in X‑ray images, the diagnosis is often delayed for many years. An important step in the direction of improved early recognition of axial SpA was establishment of the Assessment of SpondyloArthritis International Society (ASAS) classification criteria published in 2009, which focused on the initally deep-seated back pain and chronicity in relatively young patients as well as the importance of magnetic resonance imaging and HLA B 27 determination in the early stages of the disease. In order to achieve the foundations for an effective and timely therapy of affected patients, in 2014 on the initiative of the German Society of Rheumatology, S3 guidelines on axial SpA including Bechterew’s disease and early forms were formulated in cooperation with other specialist societies. This article gives an overview of the contents of the S3 guidelines on axial SpA.

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Author information

Authors and Affiliations

  1. Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland

    U. Kiltz & J. Braun

  2. Klinik Rosenhöhe, Klinikum Bielefeld, Bielefeld, Deutschland

    M. Rudwaleit

  3. Campus Benjamin-Franklin, Charité, Berlin, Deutschland

    J. Sieper

Authors
  1. U. Kiltz
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  2. M. Rudwaleit
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  3. J. Sieper
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  4. J. Braun
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Correspondence to U. Kiltz.

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Interessenkonflikt

Die bestehenden Interessenskonflikte der Leitlinienautoren für die Erstellung der S3-Leitlinie sind im Leitlinien-Report ausführlich dargestellt.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

A. Zink, Berlin

B. Hellmich, Kirchheim-Teck

Die Langfassung der Leitlinie kann unter http://www.awmf.org/leitlinien/detail/ll/060-003.html eingesehen werden.

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Kiltz, U., Rudwaleit, M., Sieper, J. et al. Evidenzbasierte Empfehlung zur Diagnostik und Therapie der axialen Spondyloarthritis. Z Rheumatol 76, 111–117 (2017). https://doi.org/10.1007/s00393-016-0232-x

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  • DOI: https://doi.org/10.1007/s00393-016-0232-x

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