CME

, Volume 14, Issue 11, pp 9–20 | Cite as

Axiale und periphere Spondyloarthritiden

Ursachen, Diagnose & Therapie
CME Fortbildung
  • 16 Downloads

Zusammenfassung

Die Spondyloarthritiden (SpA) sind entzündlich rheumatische Erkrankungen mit Manifestationen am Achsenskelett, peripheren Gelenken und Sehnen sowie extra-skelettal. In der jüngeren Nomenklatur wird die vorwiegend axiale SpA von der peripheren SpA unterschieden. Die axiale SpA wird wiederum unterteilt in die röntgenologische axiale SpA — synonym mit anklyosierender Spondylitis — und der nicht-röntgenologischen axialen SpA, definiert als axiale SpA ohne eindeutige Sakroiliitis im Röntgenbild. Genetische Faktoren spielen eine wichtige Rolle, den stärksten Einfluss hat HLA-B27. Der IL23/17 Signalweg ist immunologisch bedeutsam und liefert neue therapeutische Targets. Leitsymptom der axialen SpA ist der entzündliche Rückenschmerz mit seinen bestimmten Charakteristika. Diagnostisch sind ferner HLA-B27 sowie der Nachweis einer Sakroiliitis in der Bildgebung (Röntgen oder MRT) wichtige Parameter. Therapeutisch kommen Bewegungstherapie, NSAR (Erstlinientherapie) und Biologika (Zweitlinientherapie bei axialer SpA) zur Anwendung. Konventionelle Basistherapien sind nur bei peripherer Arthritis effektiv.

Schlüsselwörter

Spondyloarthritis ankylosierende Spondylitis Morbus Bechterew Psoriasisarthritis Therapie 

Literatur

  1. 1.
    Taurog JD, Chhabra A, Colbert RA (2016) Ankylosing Spondylitis and Axial Spondyloarthritis. N Engl J Med 374:2563–2574CrossRefPubMedGoogle Scholar
  2. 2.
    Sieper J, Poddubnyy D. Axial Spondyloarthritis. Lancet 390:73–84Google Scholar
  3. 3.
    Rudwaleit M, Jurik AG, Hermann KG et al. (2009) Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 68:1520–1527CrossRefPubMedGoogle Scholar
  4. 4.
    Lambert RG, Bakker PA, van der Heijde D et al. (2016) Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Ann Rheum Dis 75:1958–1963CrossRefPubMedGoogle Scholar
  5. 5.
    Rudwaleit M, van der Heijde D, Khan MA et al. (2004) How to diagnose axial spondyloarthritis early. Ann Rheum Dis 63:535–543CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Rudwaleit M, Khan MA, Sieper J (2005) The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum 52:1000–1008CrossRefPubMedGoogle Scholar
  7. 7.
    Rudwaleit M, Haibel H, Baraliakos X et al. (2009) The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum 60:717–727CrossRefPubMedGoogle Scholar
  8. 8.
    Khan MA, Haroon M, Rosenbaum JT (2015) Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye. Curr Rheumatol Rep 17:59CrossRefPubMedGoogle Scholar
  9. 9.
    Brown MA, Kenna T, Wordsworth BP (2016) Genetics of ankylosing spondylitis-insights into pathogenesis. Nat Rev Rheumatol 12:81–91CrossRefPubMedGoogle Scholar
  10. 10.
    International Genetics of Ankylosing Spondylitis C, Cortes A, Hadler J et al. (2013) Identification of multiple risk variants for ankylosing spondylitis through high-density genotyping of immune-related loci. Nat Genet 45:730–738CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Sherlock JP, Joyce-Shaikh B, Turner SP et al. (2012) IL-23 induces spondyloarthropathy by acting on ROR-gammat+ CD3+CD4-CD8- entheseal resident T cells. Nat Med 18:1069–1076CrossRefPubMedGoogle Scholar
  12. 12.
    Van Praet L, Van den Bosch FE, Jacques P et al. (2013) Microscopic gut inflammation in axial spondyloarthritis: a multiparametric predictive model. Ann Rheum Dis 72:414–417CrossRefPubMedGoogle Scholar
  13. 13.
    Van de Wiele T, Van Praet JT, Marzorati M et al. (2016) How the microbiota shapes rheumatic diseases. Nat Rev Rheumatol 12:398–411CrossRefPubMedGoogle Scholar
  14. 14.
    Heiland GR, Appel H, Poddubnyy D et al. (2012) High level of functional dickkopf-1 predicts protection from syndesmophyte formation in patients with ankylosing spondylitis. Ann Rheum Dis 71:572–574CrossRefPubMedGoogle Scholar
  15. 15.
    Rudwaleit M, Metter A, Listing J et al. (2006) Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum 54:569–578CrossRefPubMedGoogle Scholar
  16. 16.
    Sieper J, van der Heijde D, Landewe R et al. (2009) New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis 68:784–788CrossRefPubMedGoogle Scholar
  17. 17.
    Rudwaleit M, van der Heijde D, Landewe R et al. (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68:777–783CrossRefPubMedGoogle Scholar
  18. 18.
    Baerlecken NT, Nothdorft S, Stummvoll GH et al. (2014) Autoantibodies against CD74 in spondyloarthritis. Ann Rheum Dis 73:1211–1214CrossRefPubMedGoogle Scholar
  19. 19.
    van den Berg R, Lenczner G, Thevenin F et al. (2014) Classification of axial SpA based on positive imaging (radiographs and/or MRI of the sacroiliac joints) by local rheumatologists or radiologists versus central trained readers in the DESIR cohort. Ann Rheum Dis 74:2016–21CrossRefPubMedGoogle Scholar
  20. 20.
    Sieper J, Rudwaleit M, Braun J et al. (2002) Diagnosing reactive arthritis: role of clinical setting in the value of serologic and microbiologic assays. Arthritis Rheum 46:319–327CrossRefPubMedGoogle Scholar
  21. 21.
    Rudwaleit M, van der Heijde D, Landewe R et al. (2011) The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 70:25–31CrossRefPubMedGoogle Scholar
  22. 22.
    Aggarwal R, Ringold S, Khanna D et al. (2015) Distinctions between diagnostic and classification criteria? Arthritis Care Res (Hoboken) 67:891–897CrossRefGoogle Scholar
  23. 23.
    van der Heijde D, Ramiro S, Landewe R et al. (2017) 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 76:978–991CrossRefPubMedGoogle Scholar
  24. 24.
    Smolen JS, Braun J, Dougados M et al. (2014) Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force. Annals of the Rheumatic Diseases 73:6–16CrossRefPubMedGoogle Scholar
  25. 25.
    Sieper J, Lenaerts J, Wollenhaupt J et al. (2014) Efficacy and safety of infliximab plus naproxen versus naproxen alone in patients with early, active axial spondyloarthritis: results from the double-blind, placebo-controlled INFAST study, Part 1. Ann Rheum Dis 73:101–107CrossRefPubMedGoogle Scholar
  26. 26.
    Zochling J, Bohl-Buhler MH, Baraliakos X et al. (2006) Nonsteroidal anti-inflammatory drug use in ankylosing spondylitis—a population-based survey. Clin Rheumatol 25:794–800CrossRefPubMedGoogle Scholar
  27. 27.
    Baraliakos X, Kiltz U, Peters S et al. (2017) Efficiency of treatment with non-steroidal anti-inflammatory drugs according to current recommendations in patients with radiographic and non-radiographic axial spondyloarthritis. Rheumatology (Oxford) 56:95–102CrossRefGoogle Scholar
  28. 28.
    Rudwaleit M, Listing J, Brandt J et al. (2004) Prediction of a major clinical response (BASDAI 50) to tumour necrosis factor alpha blockers in ankylosing spondylitis. Ann Rheum Dis 63:665–670CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Rudwaleit M, Schwarzlose S, Hilgert ES et al. (2008) MRI in predicting a major clinical response to anti-tumour necrosis factor treatment in ankylosing spondylitis. Ann Rheum Dis 67:1276–1281CrossRefPubMedGoogle Scholar
  30. 30.
    Huscher D, Thiele K, Rudwaleit M et al. (2015) Trends in treatment and outcomes of ankylosing spondylitis in outpatient rheumatological care in Germany between 2000 and 2012. RMD Open 1:e000033CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Baeten D, Sieper J, Braun J et al. (2015) Secukinumab, an Interleukin-17A Inhibitor, in Ankylosing Spondylitis. New England Journal of Medicine 373:2534–2548CrossRefPubMedGoogle Scholar
  32. 32.
    Poddubnyy D, Haibel H, Listing J et al. (2012) Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Arthritis Rheum 64:1388–1398CrossRefPubMedGoogle Scholar
  33. 33.
    Wanders A, Heijde D, Landewe R et al. (2005) Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum 52:1756–1765CrossRefPubMedGoogle Scholar
  34. 34.
    Sieper J, Listing J, Poddubnyy D et al. (2016) Effect of continuous versus on-demand treatment of ankylosing spondylitis with diclofenac over 2 years on radiographic progression of the spine: results from a randomised multicentre trial (ENRADAS). Ann Rheum Dis 75:1438–1443CrossRefPubMedGoogle Scholar
  35. 35.
    Rudwaleit M, Sieper J (2012) Referral strategies for early diagnosis of axial spondyloarthritis. Nat Rev Rheumatol 8:262–268CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Klinik für Innere Medizin und RheumatologieKlinikum Bielefeld RosenhöheBielefeldDeutschland

Personalised recommendations