Skip to main content
main-content
Erschienen in: Orthopädie & Rheuma 2/2019

18.04.2019 | Schmerzen an der Wirbelsäule | Zertifizierte Fortbildung

Symptome, Diagnostik, Verlauf und Therapie

Axiale Spondyloarthritis: Am Anfang steht der entzündliche Rückenschmerz

verfasst von: Dr. med. Dieter Schöffel

Erschienen in: Orthopädie & Rheuma | Ausgabe 2/2019

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die axiale Spondyloarthritis ist eine Erkrankung, deren Vollbild über Jahrzehnte als Spondylitis ankylosans (Morbus Bechterew) bekannt war. Charakteristisch sind entzündliche Schmerzen der Wirbelsäule, Bewegungseinschränkungen sowie strukturelle Veränderungen der Iliosakralgelenke und der Wirbelsäule. Es besteht eine genetische Disposition und eine Assoziation mit diversen anderen Erkrankungen wie der Psoriasis oder chronisch entzündlichen Darmerkrankungen. Insbesondere dank der erheblich verbesserten Therapiemöglichkeiten ist der früher schicksalhafte Verlauf heutzutage gut beeinflussbar.
Literatur
1.
Zurück zum Zitat Braun, J., et al., Prevalence of spondylarthropathie s in HLA-B27 positive and negative blood donors. Arthritis Rheum, 1998 41 (1): p. 58–67. CrossRef Braun, J., et al., Prevalence of spondylarthropathie s in HLA-B27 positive and negative blood donors. Arthritis Rheum, 1998 41 (1): p. 58–67. CrossRef
2.
Zurück zum Zitat Zink, A., et al., Disability and handicap in rheumatoid arthritis and ankylosing spondylitis—results from the German rheumatological database. German Collaborative Arthritis Centers. J Rheumatol, 2000. 27(3): p. 613–22 PubMed Zink, A., et al., Disability and handicap in rheumatoid arthritis and ankylosing spondylitis—results from the German rheumatological database. German Collaborative Arthritis Centers. J Rheumatol, 2000. 27(3): p. 613–22 PubMed
3.
Zurück zum Zitat Vander Cruyssen, B., et al., The epidemiology of ankylosing spondylitis and the commencement of anti-TNF therapy in daily rheumatology practice. Ann Rheum Dis, 2007. 66 (8): p. 1072–7. CrossRef Vander Cruyssen, B., et al., The epidemiology of ankylosing spondylitis and the commencement of anti-TNF therapy in daily rheumatology practice. Ann Rheum Dis, 2007. 66 (8): p. 1072–7. CrossRef
4.
Zurück zum Zitat Peters, M.J., et al., Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum, 2004; 34, (3): p. 585–92 CrossRef Peters, M.J., et al., Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum, 2004; 34, (3): p. 585–92 CrossRef
5.
Zurück zum Zitat Kiltz U. Baraliakos X, Borg AA. Spondyloarthropathies: Pathogenesis and Clinical Features. EULAR Textbook on Rheumatology 2016 Kiltz U. Baraliakos X, Borg AA. Spondyloarthropathies: Pathogenesis and Clinical Features. EULAR Textbook on Rheumatology 2016
6.
Zurück zum Zitat Rudwaleit M, Haibel H, Baraliakos X et al., The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum, 2009. 60(3): p. 717–27 CrossRef Rudwaleit M, Haibel H, Baraliakos X et al., The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum, 2009. 60(3): p. 717–27 CrossRef
7.
Zurück zum Zitat van den Berg R, Lenczner G, FEydy A et al. Agreement between clinical practice and trained central reading in reading of plain pelvic radiographs. Results oft he DESIR cohort. Arthritis Rheumatol 2014, 66: 24032411 van den Berg R, Lenczner G, FEydy A et al. Agreement between clinical practice and trained central reading in reading of plain pelvic radiographs. Results oft he DESIR cohort. Arthritis Rheumatol 2014, 66: 24032411
8.
Zurück zum Zitat van Tubergen A, Heuft-Dorenbosch L, Schulpen G et al. Radiographic assessment ofsacroiliitis by radiologists and rheumatologists. Does training improve quality? Ann Rheum Dis 2003, 62, 19–25 van Tubergen A, Heuft-Dorenbosch L, Schulpen G et al. Radiographic assessment ofsacroiliitis by radiologists and rheumatologists. Does training improve quality? Ann Rheum Dis 2003, 62, 19–25
9.
Zurück zum Zitat Baraliakos X1, van der Heijde D, Braun J, Landewé RB. OMERACT magnetic resonance imaging initiative on structural and inflammatory lesions in ankylosing spondylitis—report of a special interest group at OMERACT 10 on sacroiliac joint and spine lesions. J Rheumatol. 2011 Sep;38(9):2051–4 CrossRef Baraliakos X1, van der Heijde D, Braun J, Landewé RB. OMERACT magnetic resonance imaging initiative on structural and inflammatory lesions in ankylosing spondylitis—report of a special interest group at OMERACT 10 on sacroiliac joint and spine lesions. J Rheumatol. 2011 Sep;38(9):2051–4 CrossRef
10.
Zurück zum Zitat Song, I.H., et al., The diagnostic value of scintigraphy in assessing sacroiliitis in ankylosing spondylitis: a systematic literature research. Ann Rheum Dis, 2008. 67(11): p. 1535–40 CrossRef Song, I.H., et al., The diagnostic value of scintigraphy in assessing sacroiliitis in ankylosing spondylitis: a systematic literature research. Ann Rheum Dis, 2008. 67(11): p. 1535–40 CrossRef
11.
Zurück zum Zitat AWMF-Leitlinie „Axiale Spondyloarthritis inklusive Morbus Bechterew und Frühformen“, Register-Nr. 060/003, S3-Leitlinie, Version November 2013. AWMF-Leitlinie „Axiale Spondyloarthritis inklusive Morbus Bechterew und Frühformen“, Register-Nr. 060/003, S3-Leitlinie, Version November 2013.
12.
Zurück zum Zitat Deodhar A, Strand V, Kay J und Braun J. The term „non-radiographic axial spondyloarthritis“ is much more important to classify than to diagnose patients with axial spondyloarthritis. Ann Rheum Dis 2016, 75: 791–794 CrossRef Deodhar A, Strand V, Kay J und Braun J. The term „non-radiographic axial spondyloarthritis“ is much more important to classify than to diagnose patients with axial spondyloarthritis. Ann Rheum Dis 2016, 75: 791–794 CrossRef
13.
Zurück zum Zitat Rudwaleit M, Landewe R, van der Hejde D et al. 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 2009; 68, 770–776 CrossRef Rudwaleit M, Landewe R, van der Hejde D et al. 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 2009; 68, 770–776 CrossRef
14.
Zurück zum Zitat Rudwaleit M, van der Hejde D, Landewe R et al. The development of Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68, 777–783 CrossRef Rudwaleit M, van der Hejde D, Landewe R et al. The development of Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68, 777–783 CrossRef
15.
Zurück zum Zitat Baraliakos, X, Listing J, Rudwaleit M et al. Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes. Ann Rheum Dis, 2007. 66 (7): p. 910–915 CrossRef Baraliakos, X, Listing J, Rudwaleit M et al. Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes. Ann Rheum Dis, 2007. 66 (7): p. 910–915 CrossRef
16.
Zurück zum Zitat Poddubnyy, D., et al., Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Arthritis Rheum, 2012. 64(5): p. 1388–98. CrossRef Poddubnyy, D., et al., Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Arthritis Rheum, 2012. 64(5): p. 1388–98. CrossRef
17.
Zurück zum Zitat Sampaio-Barros PD, Bortoluzzo AB, Conde RA et al. Undifferentiated Sondyloarthritis: a longterm follow-up. J Rheumatol 2010; 37, 1195–1199) CrossRef Sampaio-Barros PD, Bortoluzzo AB, Conde RA et al. Undifferentiated Sondyloarthritis: a longterm follow-up. J Rheumatol 2010; 37, 1195–1199) CrossRef
18.
Zurück zum Zitat Garrett S, Jenkinson T, Kennedy LG et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21(12):2286–91. PubMed Garrett S, Jenkinson T, Kennedy LG et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21(12):2286–91. PubMed
19.
Zurück zum Zitat Lukas C, Landewé R, Sieper J, Dougados M, Davis J, Braun J, van der Linden S, van der Heijde D. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68:18–24 CrossRef Lukas C, Landewé R, Sieper J, Dougados M, Davis J, Braun J, van der Linden S, van der Heijde D. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68:18–24 CrossRef
20.
Zurück zum Zitat Lim, H.J., Y.I. Moon, and M.S. Lee, Effects of home-based daily exercise therapy on joint mobility, daily activity, pain, and depression in patients with ankylosing spondylitis. Rheumatol Int, 2005. 25(3): p. 225–9 CrossRef Lim, H.J., Y.I. Moon, and M.S. Lee, Effects of home-based daily exercise therapy on joint mobility, daily activity, pain, and depression in patients with ankylosing spondylitis. Rheumatol Int, 2005. 25(3): p. 225–9 CrossRef
21.
Zurück zum Zitat Passalent, L.A., et al., vExercise in ankylosing spondylitis: discrepancies between recommendations and reality. J Rheumatol, 2010. 37(4): p. 835–41. CrossRef Passalent, L.A., et al., vExercise in ankylosing spondylitis: discrepancies between recommendations and reality. J Rheumatol, 2010. 37(4): p. 835–41. CrossRef
22.
Zurück zum Zitat Wanders, A., et al., Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum, 2005. 52(6): p. 1756–65. CrossRef Wanders, A., et al., Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum, 2005. 52(6): p. 1756–65. CrossRef
23.
Zurück zum Zitat Kroon, F, Landewé, R, Dougados, M. Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis. Ann Rheum Dis 2012; 71: 1623–162 CrossRef Kroon, F, Landewé, R, Dougados, M. Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis. Ann Rheum Dis 2012; 71: 1623–162 CrossRef
24.
Zurück zum Zitat Sieper J, Listing J, Poddubnyy D. 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 2016;75:1438–43 CrossRef Sieper J, Listing J, Poddubnyy D. 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 2016;75:1438–43 CrossRef
25.
Zurück zum Zitat Chen J, Lin S, Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database Syst Rev, 2005(2): p. CD004800 Chen J, Lin S, Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database Syst Rev, 2005(2): p. CD004800
26.
Zurück zum Zitat van der Heijde D, Ramiro S, Landewé R et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017 Jun; 76(6):978–991 CrossRef van der Heijde D, Ramiro S, Landewé R et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017 Jun; 76(6):978–991 CrossRef
27.
Zurück zum Zitat Maugars, Y., et al., Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Br J Rheumatol, 1996. 35(8): p. 767–70 CrossRef Maugars, Y., et al., Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Br J Rheumatol, 1996. 35(8): p. 767–70 CrossRef
28.
Zurück zum Zitat Zochling J, van der Heijde D, Dougados M, Braun J. Current evidence for the manage ment of ankylosing spondylitis: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Ann Rheum Dis, 2006. 65(4): p. 423–32 CrossRef Zochling J, van der Heijde D, Dougados M, Braun J. Current evidence for the manage ment of ankylosing spondylitis: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Ann Rheum Dis, 2006. 65(4): p. 423–32 CrossRef
29.
Zurück zum Zitat Visvanathan, S., et al., Effects of infliximab on markers of inflammation and bone turnover and associations with bone mineral density in patients with ankylosing spondylitis. Ann Rheum Dis, 2009. 68 (2): p. 175–82 CrossRef Visvanathan, S., et al., Effects of infliximab on markers of inflammation and bone turnover and associations with bone mineral density in patients with ankylosing spondylitis. Ann Rheum Dis, 2009. 68 (2): p. 175–82 CrossRef
30.
Zurück zum Zitat Dougados, M., et al., Efficacy of etanercept on rheumatic signs and pulmonary function tests in advanced ankylosing spondylitis: results of a randomised double-blind placebo-controlled study (SPINE). Ann Rheum Dis, 2011. 70(5): p. 799–804 CrossRef Dougados, M., et al., Efficacy of etanercept on rheumatic signs and pulmonary function tests in advanced ankylosing spondylitis: results of a randomised double-blind placebo-controlled study (SPINE). Ann Rheum Dis, 2011. 70(5): p. 799–804 CrossRef
31.
Zurück zum Zitat van der Heijde D, Baraliakos X, Hermann KA et al. Limited radiographic progression and sustained reductions in MRI inflammation in patients with axial spondyloarthritis: 4-year imaging outcomes from the RAPIDaxSpA phase III randomised trial. Ann Rheum Dis. 2018 May;77(5): 699–705 CrossRef van der Heijde D, Baraliakos X, Hermann KA et al. Limited radiographic progression and sustained reductions in MRI inflammation in patients with axial spondyloarthritis: 4-year imaging outcomes from the RAPIDaxSpA phase III randomised trial. Ann Rheum Dis. 2018 May;77(5): 699–705 CrossRef
32.
Zurück zum Zitat Mease P. van der Heijde D, Ritchlin C et al. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann Rheum Dis. 2017 Jan; 76(1): 79–87 CrossRef Mease P. van der Heijde D, Ritchlin C et al. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann Rheum Dis. 2017 Jan; 76(1): 79–87 CrossRef
33.
Zurück zum Zitat Sepriano A, Regel A, van der Heijde D, Efficacy and safety of biological and targeted-synthetic DMARDs: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis. RMD Open. 2017 Jan 27;3(1) Sepriano A, Regel A, van der Heijde D, Efficacy and safety of biological and targeted-synthetic DMARDs: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis. RMD Open. 2017 Jan 27;3(1)
34.
Zurück zum Zitat van der Heijde D, Cheng-Chung Wei J, Dougados M et al. Ixekizumab, an interleukin17A antagonist in the treatment of ankylosing spondylitis or radiographic axial spondyloarthritis in patients previously untreated with biological disease-modifying antirheumatic drugs. Lancet 2018; 392, 2441–2451. CrossRef van der Heijde D, Cheng-Chung Wei J, Dougados M et al. Ixekizumab, an interleukin17A antagonist in the treatment of ankylosing spondylitis or radiographic axial spondyloarthritis in patients previously untreated with biological disease-modifying antirheumatic drugs. Lancet 2018; 392, 2441–2451. CrossRef
35.
Zurück zum Zitat Song IH, Heldmann F, Rudwaleit M et al. Treatment of active ankylosing spondylitis with abatacept: an open-label, 24-week pilot study. Ann Rheum Dis 2011;70:1108–10 CrossRef Song IH, Heldmann F, Rudwaleit M et al. Treatment of active ankylosing spondylitis with abatacept: an open-label, 24-week pilot study. Ann Rheum Dis 2011;70:1108–10 CrossRef
Metadaten
Titel
Symptome, Diagnostik, Verlauf und Therapie
Axiale Spondyloarthritis: Am Anfang steht der entzündliche Rückenschmerz
verfasst von
Dr. med. Dieter Schöffel
Publikationsdatum
18.04.2019

Weitere Artikel der Ausgabe 2/2019

Orthopädie & Rheuma 2/2019 Zur Ausgabe

Passend zum Thema

ANZEIGE
Kasuistik

Kausale Therapie muskulär bedingter Nacken-/Schulterschmerzen

Schmerzen im Bereich von Rücken, Nacken und Schultern sind meist muskulär bedingt. Demnach adressieren Analgetika nicht die eigentliche Schmerzursache. Wohingegen Muskelrelaxantien ursächlich gegen muskulär bedingte Schmerzen wirken und auch im orthopädischen Praxisalltag zunehmend Anwendung finden.