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Differenzialdiagnose axiale Spondyloarthritis – „axSpA mimics“

Differential diagnosis of axial spondyloarthritis—axSpA mimics

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Zusammenfassung

Die Klassifikation axiale Spondyloarthritis (axSpA) umfasst die klassische Spondylitis ankylosans (AS), die durch bereits bestehende Strukturveränderungen in den Sakroiliakalgelenken charakterisiert ist, und die sog. nicht-röntgenologische axSpA (nr-axSpA), bei der solche Veränderungen definitionsgemäß nicht vorhanden sind. Die Grundlage dieser Unterscheidung sind die ASAS(Assessment of SpondyloArthritis international Society)-Klassifikationskriterien für axSpA, die für die Diagnosestellung aber nicht geeignet sind. Der heute gängigen Einteilung zufolge umfassen die Spondyloarthritiden (SpA) die axiale SpA, die mit Psoriasis, Morbus Crohn und Colitis ulcerosa assoziiert sein kann, und die periphere SpA, die sich weiter unterteilt in die SpA bei Psoriasis, partiell synonym Psoriasisarthritis (PsA), die reaktive SpA, partiell synonym reaktive Arthritis (ReA), und die SpA bei chronisch entzündlichen Darmerkrankungen (CED), partiell synonym mit Arthritiden, die mit chronisch entzündlichen Darmerkrankungen assoziiert sind (wie Morbus Crohn, Colitis ulcerosa), und die periphere undifferenzierte SpA, bei der definitionsgemäß keine der oben aufgeführten Assoziationen vorliegt. In der vorliegenden Arbeit werden nur die wichtigsten Differenzialdiagnosen behandelt – d. h. die diffuse idiopathische skeletale Hyperostose (DISH), Frakturen und Infektionen im Achsenskelett. Darüber hinaus geht es um die Häufigkeit von bestimmten muskuloskeletalen Befunden in der mit Magnetresonanztomographie (MRT) untersuchten Normalbevölkerung.

Abstract

The classification of axial spondyloarthritis (axSpA) comprises the classical ankylosing spondylitis (AS), which is characterized by already existing structural changes in the sacroiliac joints, and the so-called non-radiographic axSpA (nr-axSpA), in which by definition such changes are not present. This distinction is based on the ASAS classification criteria for axSpA, which are however not suitable for a diagnosis. According to the current classification, spondyloarthritis (SpA) includes axSpA, which can be associated with psoriasis and/or chronic inflammatory bowel diseases (CED), such as Crohn’s disease and ulcerative colitis, and peripheral SpA, which is further divided into SpA associated with psoriasis, partially synonymous with psoriatic arthritis (PsA), reactive SpA, partially synonymous with reactive arthritis (ReA) and SpA associated with CED, partially synonymous with arthritis associated with CED (e.g. Crohn’s disease, ulcerative colitis) and peripheral undifferentiated SpA, which by definition is not associated with any of the above. In this article only the most important differential diagnoses are discussed, i. e. diffuse idiopathic skeletal hyperostosis (DISH), fractures and infections in the axial skeleton. In addition, the frequency of certain musculoskeletal findings in the normal population examined by magnetic resonance imaging (MRI) are also discussed.

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    J. Braun, X. Baraliakos, B. Buehring, M. Fruth & U. Kiltz

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Braun, J., Baraliakos, X., Buehring, B. et al. Differenzialdiagnose axiale Spondyloarthritis – „axSpA mimics“. Z Rheumatol 78, 31–42 (2019). https://doi.org/10.1007/s00393-018-0557-8

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