Skip to main content

Advertisement

SpringerLink
Log in

Spondyloarthritiden

Spondyloarthritides

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Die Spondyloarthritiden (SpA) sind eine durch klinische Symptome und genetische Prädisposition verbundene Gruppe von entzündlich-rheumatischen Erkrankungen. Der wichtigste Subtyp ist die ankylosierende Spondylitis (AS), die jetzt der Gruppe der axialen SpA zugeordnet wird. Die anderen Subtypen sind die SpA bei Psoriasis, nach vorausgehenden Infektionen (ReSpA), assoziiert mit chronisch-entzündlichen Darmerkrankungen (SpACED) und die undifferenzierte SpA (uSpA). Die wichtigsten klinischen Symptome der SpA sind der entzündliche Rückenschmerz und die periphere, meist asymmetrische Oligoarthritis und Enthesitis. Die z. T. typische Beteiligung anderer Organe umfasst die Augen (anteriore Uveitis), die Haut (Psoriasis), den Darm (wie CED) u. a. Die typischen Symptome beginnen bei AS meist in den Sakroiliakalgelenken im Alter von etwa 26 Jahren, Männer sind etwas häufiger betroffen als Frauen. USpA-Patienten entwickeln zu etwa 50% im Verlauf der Erkrankung eine definitive AS. Der stärkste genetische Faktor, das HLA-B27, ist bei etwa 90% der AS-Patienten vorhanden.

Die konventionelle Radiographie ist immer noch der Goldstandard für die Diagnostik des Achsenskeletts. Die neuen ASAS-Klassifikationskriterien haben die Frühdiagnostik der SpA verbessert, weil die MRT und die frühe Bestimmung von HLA-B27 hierbei eine wichtige Rolle spielen.

Abstract

The spondyloarthritides (SpA) are an interrelated group of rheumatic diseases that are characterized by common clinical symptoms and genetic similarities. The most important subtype is ankylosing spondylitis (AS), which is now considered part of axial spondyloarthritis. Important clinical features of the SpA are inflammatory back pain (IBP), asymmetric peripheral oligoarthritis, predominantly of the lower limbs, enthesitis, and specific organ involvement such as anterior uveitis, psoriasis and chronic inflammatory bowel disease. For clinical purposes, five subgroups are differentiated: AS, psoriatic SpA (PsSpA), reactive SpA (ReSpA), SpA associated with inflammatory bowel disease (SpAIBD) and undifferentiated SpA (uSpA). AS usually starts in the sacroiliac joints at a mean age of 26 years, affecting men slightly more frequently than women. SpA are genetically linked (90% of cases), the strongest contributing factor being HLA B27.

Conventional radiography remains the gold standard for diagnosis in the axial skeleton. The new ASAS classification criteria have helped to improve the early diagnosis of SpA, with MRI and early HLA B27 determination playing an important role.

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
Abb. 2

Literatur

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

    Article  PubMed  Google Scholar 

  2. Zochling J, Brandt J, Braun J (2005) The current concept of spondyloarthritis with special emphasis on undifferentiated spondyloarthritis. Rheumatology (Oxford) 44(12):1483–1491

    Google Scholar 

  3. Taylor W, Gladman D, Helliwell P et al; CASPAR Study Group (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54(8):2665–2673

    Article  PubMed  Google Scholar 

  4. Kahn MF, Khan MA (1994) The SAPHO syndrome. Baillieres Clin Rheumatol 8(2):333–362

    Article  CAS  PubMed  Google Scholar 

  5. 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(2):569–578

    Article  PubMed  Google Scholar 

  6. Sieper J, van der Heijde D, Landewé 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(6):784–788 [Epub 2009 Jan 15]

    Article  CAS  PubMed  Google Scholar 

  7. Rudwaleit M, Landewé R, van der Heijde D et al (2009) The development of Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (part I): Classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis [Epub ahead of print Mar 17]

  8. Rudwaleit M, van der Heijde D, Landewé R et al (2009) The development of Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis [Epub ahead of print Mar 17]

  9. Dougados M, van der Linden S, Juhlin R et al (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34(10):1218–1227

    Article  CAS  PubMed  Google Scholar 

  10. Amor B, Dougados M, Mijiyawa M (1990) Criteria of the classification of spondylarthropathies. Rev Rhum Mal Osteoartic 57(2):85–89

    CAS  PubMed  Google Scholar 

  11. van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368

    Article  Google Scholar 

  12. Rudwaleit M, van der Heijde D, Khan MA et al (2004) How to diagnose axial spondyloarthritis early. Ann Rheum Dis 63(5):535–543

    Article  CAS  PubMed  Google Scholar 

  13. Rudwaleit M, Haibel H, Baraliakos X et al (200) The early disease stage in axial spondylarthritis: Results from the German spondyloarthritis inception cohort. Arthritis Rheum 60(3):717–727

    Article  Google Scholar 

  14. Sieper J, Rudwaleit M, Baraliakos X et al (2009) The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 68 Suppl 2:ii1–44

    Article  Google Scholar 

  15. Braun J, Bollow M, Eggens U et al (1994) Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. Arthritis Rheum 37(7):1039–1045

    Article  CAS  PubMed  Google Scholar 

  16. Braun J, Bollow M, Sieper J (1998) Radiologic diagnosis and pathology of the spondyloarthropathies. Rheum Dis Clin North Am 24(4):697–735

    Article  CAS  PubMed  Google Scholar 

  17. 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(5):1646–1652

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  19. Kiltz U, Heijde D van der, Mielants H et al (2009) ASAS/EULAR recommendations for the management of ankylosing spondylitis: the patient version. Ann Rheum Dis 68(9):1381–1386

    Article  CAS  PubMed  Google Scholar 

  20. 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(3):316–320

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. St. Josefs-Krankenhaus, Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Landgrafenstr. 15, 44652, Herne, Deutschland

    J. Braun

  2. Charité-Universitätsmedizin Berlin, 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. Spondyloarthritiden. Z. Rheumatol. 69, 425–434 (2010). https://doi.org/10.1007/s00393-009-0591-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-009-0591-7

Schlüsselwörter

Keywords

Search

Navigation