Spondyloarthritiden und Früh diagnose

Zusammenfassung

In den vergangenen 40 Jahren wurden infolge ätiopathogenetischer, klinischer und diagnostischer Fortschritte in wechselnder Folge Kriterien mit dem Ziel einer Frühdiagnose und Klassifizierung der Spondylitis ankylosans und Spondyloarthritiden entwickelt. Die Historie der für die Frühdiagnose relevanten Fortschritte und Grenzen wird aufgezeigt. Das Konzept einer Familie bzw. Gruppe von Erkrankungen, die durch überlappende familiäre, genetische und klinische Manifestationen miteinander verbunden sind, ist nicht überholt. Die Unterteilung der SpA in definierte nosologische Kategorien für die Diagnose und Frühdiagnose einzelner Patienten, die Patienteninformation, die individuelle Behandlung und die prognostische Beurteilung wird weiterhin benötigt. Infektionen, insbesondere mit Chlamydien, werden als auslö-sender Faktor und ätiologischer Beitrag zur Diagnose der Spondyloarthritis nicht ausreichend berücksichtigt. Die ASAS-Klassifikationskriterien für die axiale und periphere Spondyloarthritis sind für Studien wichtig, jedoch in der Praxis nicht unkritisch für die Frühdiagnose einsetzbar. Zukünftige Möglichkeiten zur Verbesserung der Frühdiagnose werden angesprochen.

Summary

Over the past 40 years criteria were developed in alternating sequence for early diagnosis and classification of ankylosing spondylitis and spondyloarthritis as a result of etiopathogenetic, clinical and diagnostic advances. The history is presented related to progress and limitations for early diagnosis. The concept of a family or group of diseases which are connected by overlapping familial, genetic, and clinical manifestations is not outdated. The subdivision of SpA in defined nosological categories is still required for diagnosis and early diagnosis of individual patients, patient information, individualized treatment, and prognostic evaluation. Infections, especially with Chlamydia, are not considered sufficiently as a causative factor and etiological contribution to the diagnosis of spondyloarthritis. The ASAS classification criteria for axial and peripheral spondylo -arthritis are important for studies, but should not be used uncritically in practice for early diagnosis. Future opportunities will be addressed how to improve early diagnosis.

Schlüsselwörter

Spondyloarthritiden - Frühdiagnose - Klassifikationskriterien - Infektdiagnostik

Keywords

Spondyloarthritides - early diagnosis - classification criteria - diagnosis of infection

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