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Spondyloarthritiden

Spondylarthritides

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Zusammenfassung

Die Spondyloarthritiden (SpA) sind eine durch klinische Symptome und genetische Prädisposition verbundene Gruppe entzündlich-rheumatischer Erkrankungen, deren bedeutendster Subtyp die ankylosierende Spondylitis (AS) ist. Die wichtigsten klinischen Symptome sind der entzündliche Rückenschmerz und die periphere, meist asymmetrische Oligoarthritis und Enthesitis sowie die anteriore Uveitis, die Psoriasis und die Colitis. Etablierte Klassifikationskriterien für die AS sind in frühen Krankheitsphasen zu wenig sensitiv. Dies trägt neben der hohen Prävalenz von Rückenschmerzen in der Bevölkerung zur verspäteten Diagnosestellung der AS bei. Die Möglichkeiten für die Früherkennung von SpA haben sich in den letzten Jahren jedoch verbessert, v. a. durch die frühe Bestimmung von HLA-B27 und die Magnetresonanztomographie. Die konventionelle Radiographie ist hier aber nach wie vor der diagnostische Goldstandard. Internationale Empfehlungen für das Management der AS wurden kürzlich publiziert. Die konventionelle medikamentöse Behandlung besteht v. a. aus nichtsteroidalen Antiphlogistika (NSAR), vor allem bei Patienten mit peripherer Arthritis ist eine Therapie mit intraartikulären Kortikosteroiden und Sulfasalazin gerechtfertigt. Patienten mit persistierend erhöhter Entzündungsaktivität profitieren von einer Therapie mit TNF-Blockern. Für den generellen Behandlungsansatz bei SpA-Patienten ist die Physiotherapie von großer Bedeutung.

Abstract

Ankylosing spondylitis (AS) is the major subtype and a major outcome of an interrelated group of rheumatic diseases now named as spondyloarthritides (SpA). The most important clinical features of this group are inflammatory back pain (IBP), asymmetric peripheral oligoarthritis, predominantly of the lower limbs, and enthesitis. Established classification criteria for AS and SpA are known to perform less well in early disease stages. This partly contributes to the delay in diagnosis, mainly due the high frequency of back pain in the population. The methods for making an early diagnosis have recently improved. The major factors involved in this improvement are HLA B27 and magnetic resonance imaging of the sacroiliac joints, but also of the spine. Conventional radiography, however, is still the gold standard. International recommendations for the management of AS have recently been published. Conventional medical treatment is based mainly on the use of non-steroidal anti-inflammatory agents (NSAIDs); patients with peripheral arthritis may be treated with sulfasalazine. Patients with persistently active disease benefit from therapy with anti-TNF agents. Physiotherapy is of major importance in the general approach to patients with SpA, especially with AS.

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Braun, J., Sieper, J. Spondyloarthritiden. Z. Rheumatol. 65, 613–632 (2006). https://doi.org/10.1007/s00393-006-0116-6

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