Diagnostik und Klassifikation der axialen Spondyloarthritis (axSpA) – der aktuelle Stand

Zusammenfassung

Die axiale Spondyloarthritis (axSpA) ist eine entzündlich-rheumatische Erkrankung, die typischerweise durch entzündlichen Rückenschmerz (eRs) gekennzeichnet ist. Der Terminus axSpA hat den lange gebräulichen Begriff ankylosierende Spondylitis (AS) weitgehend abgelöst. Der eRs ist durch Entzündung im Achsenskelett bedingt, wobei die Sakroiliakalgelenke (SIG) initial besonders häufig betroffen sind. Meist in späteren Stadien kommt die Wirbelsäule hinzu, was strukturell dann zunehmend durch Knochenneubildung gekennzeichnet ist. Zum Gesamktonzept der Spondyloarthritiden gehören weitere Krankheitsmanifestationen wie Uveitis, Psoriasis und Colitis und Komorbiditäten wie kardiovaskuläre Erkrankungen und Osteoporose.

Für die axSpA gibt es seit 2009 die ASAS-Klassifikationskriterien, die die 1984 modifizierten New York-Kriterien abgelöst haben. Bei ersteren spielen über das konventionelle Röntgen hinaus erstmals mit Magnetresonanztomographie (MRT) festgestellte Veränderungen in der Bildgebung der SIG und auch der Nachweis von HLA B27 eine Rolle. Wichtig ist, dass es sich nicht um diagnostische Kriterien handelt, denn die gibt es nicht. In dieser Arbeit werden 10 Punkte aufgezeigt, die bei der Diagnosestellung berücksichtigt werden sollten.

Abstract

Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease typically characterized by inflammatory back pain (IBP). The term axSpA has largely replaced the long-used term ankylosing spondylitis (AS). IBP is caused by inflammation in the axial skeleton, with the sacroiliac joints (SIJ) being particularly frequently affected initially. The spine is usually added in later stages, which is then increasingly characterized structurally by the formation of new bone. The overall concept of spondyloarthritis includes other disease manifestations such as uveitis, psoriasis and colitis and comorbidities such as cardiovascular disease and osteoporosis.

The ASAS classification criteria for axSpA, in place since 2009, have replaced the 1984 modified New York criteria. In the former, in addition to conventional X-rays, changes in the SIJ detected by magnetic resonance imaging (MRI) and also the detection of HLA B27 have, for the first time, played a role. It is important to note that these are not diagnostic criteria, as they do not exist. This paper outlines 10 points that should be considered when making a diagnosis.

Schlüsselwörter

ankylosierende Spondylitis - HLA B27 - Sakroiliakalgelenk

Keywords

ankylosing spondylitis - HLA B27 - sacroiliac joint

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