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Arthritis und Rheuma 2016; 36(02): 83-91
DOI: 10.1055/s-0037-1617491
Leitsymptom Rückenschmerz
Schattauer GmbH

Evidenzbasierte Empfehlung zur Diagnostik und Therapie der axialen Spondyloarthritis

Die S3-Leitlinie der Deutschen Gesellschaft für Rheumatologie (DGRh) in Kooperation mit der AWMFGerman recommendations for the management of axial spondyloarthritisThe S3 Guideline of the German Society of Rheumatology (DGRh) in Cooperation with the AWMF
U. Kiltz
1   Rheumazentrum Ruhrgebiet, Herne
,
M. Rudwaleit
2   Klinikum Bielefeld, Klinik Rosenhöhe, Bielefeld
,
J. Sieper
3   Charité, Campus Benjamin Franklin, Berlin
,
J. Braun
1   Rheumazentrum Ruhrgebiet, Herne
› Author Affiliations
Further Information

Publication History

Publication Date:
27 December 2017 (online)

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Zusammenfassung

Der klinische Verlauf der axialen Spondyloarthritis (SpA) ist ziemlich variabel. Im Vordergrund stehen entzündliche chronische Rückenschmerzen, aber auch extraspinale Manifestationen wie asymmetrische Oligoarthritis, Enthesitis und Daktylitis. Nicht wenige Patienten haben auch extraartikuläre Manifestationen an Augen (anteriore Uveitis), Haut (Psoriasis) oder Darm (chronisch entzündliche Darmerkrankungen). Durch die Heterogenität des klinischen Bildes, der teilweise schwierigen Bewertung klinischer Symptome und der Konzentration auf konventionell röntgenologisch festgestellte strukturelle Veränderungen in den Sakroiliakalgelenken (New-York-Kriterien 1984 für ankylosierende Spondylitis) ist es zu einer mehrere Jahre betragenden Verzögerung bei der Diagnosestellung gekommen. Ein wichtiger Schritt in Richtung Früherkennung waren die 2009 publizierten ASAS-Klassifikationskriterien für axSpA, die sowohl die Bedeutung der Magnet -resonanztomografie als auch die Bestimmung von HLA-B27 in frühen Phasen der Erkrankung betonen. Um die Grundlagen für eine effektive und frühzeitige Therapie der betroffenen Patienten zu gewährleisten, ist dann im Jahr 2014 auf Initiative der Deutschen Gesellschaft für Rheumatologie (DGRh) eine S3-Leitlinie “Axiale Spondylo arthritis inklusive Morbus Bechterew und Frühformen” unter Mitwirkungen vieler anderer Fachgesellschaften erstellt worden. Dieser Artikel gibt einen Überblick über den Inhalt der S3-Leitlinie zur axialen SpA.

Summary

The clinical course of spondyloarthritis (SpA) is variable with inflammatory back pain as the main presenting symptom. Patients might suffer from extraspinal manifestations such as asymmetric oligoarthritis, enthesitis and dactylitis as well as extraarticular manifestations such as uveitis, psoriasis and inflammatory bowel disease. Heterogeneous picture of the disease, challenging aspects of assessment and the concentration on structural damage added to the diagnostic delay of the disease. The publication of the ASAS classification criteria for axial SpA in 2009 was a big step forward because of its alignment on magnetic resonance imaging and assessment of HLA-B27 in patients with suspicion of SpA. The German Association of Rheumatology (DGRh) has published in 2014 a guideline on “Axial SpA including ankylosing spondylitis and early stages” to inform about the principles of diagnosis and treatment in patients with all forms of axial SpA. This article is giving an overview on the recommendations of this German S3-guideline.

Schlüsselwörter

Spondyloarthritis - Leitlinie - ASAS-Klassifikationskriterien

Keywords

Spondyloarthritis - guideline - ASAS classification criteria
 

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