Rheuma und chronisch-entzündliche Darmerkrankungen

Zusammenfassung

Spondyloarthritiden unterteilen sich hinsichtlich der Skelettmanifestation in eine periphere und axiale Form und finden sich bei Morbus Crohn und Colitis ulcerosa in ca. 25 % der Fälle als extraintestinale Manifestation. Die Diagnostik beruht auf typischen klinischen Merkmalen bei der axialen Spondyloarthritis. Hier findet sich ein tiefer entzündlicher Rückenschmerz und eine Sakroiliitis (konventionell-radiologisch oder mittels MRT nachgewiesen). Die Diagnose der peripheren Beteiligung bei Spondyloarthritis richtet sich nach dem klinischen Bild unter Berücksichtigung von Krankheitsmerkmalen wie Arthritis, Enthesitis und Daktylitis. Im Vordergrund der Therapie der Spondyloarthritiden mit chronisch- entzündlicher Darmerkrankung (CED) steht neben der intensiven Physiotherapie die kurzfristige Gabe von nichtsteroidalen Antirheumatika (NSAR), da bei längerer Einnahme von NSAR Schübe der CED ausgelöst werden können. Cox-2-Hemmer können hier eine Alternative zu den herkömmlichen NSAR darstellen. Bei der axialen Spondyloarthritis sind Sulfasalazin und MTX weniger wirksam, weshalb möglichst früh eine Therapie mit Biologika gestartet werden sollte. Bei der Spondyloarthritis mit einer peripheren Arthritis können initial kurzfristig verabreichte orale Kortikosteroide effektiv sein, bei persistierender Arthritis kann eine Behandlung mit Sulfasalazin oder Methotrexat versucht werden. Auch für diese Verlaufsformen der Spondylo - arthritis gilt, bei therapieresistenten Fällen möglichst frühzeitig Biologika einzusetzen.

Summary

Both peripheral and axial arthropathies, which belong to the spondyloarthritis (SpA) group of conditions, occur as extra-intestinal manifestations (EIM) of Crohn’s disease (CD) and ulcerative colitis (UC) in 25 % of the cases. Diagnosis of axial SpA is based on typical clinical features such as inflammatory low back pain and sacroiliitis evidenced by magnetic resonance- or conventional radiographic imaging. Diagnosis of peripheral arthropathy is based on clinical signs of arthritis, enthesitis or dactylitis. Therapy of spondyloarthritis associated with IBD focusses on an intense physical therapy and a short-term application of non-steroidal antiinflammatory drugs (NSAIDs). As the longterm use of NSAID may trigger an exacerbation of IBD Coxibs represent an appropriate alternative. Sulfasalazine and methotrexate are of limited efficacy in the treatment of axial spondyloarthritis, so that the administration of suitable biologicals should be initiated as early as possible. Short-term oral corticosteroids can be effective in the treatment of a peripheral spondyloarthritis, in persistent arthritis a sulfasalazine- or methotrexate- therapy can be considered a promising option. The early use of biologicals is recommended in all cases resistant to the conventional therapeutic approach.

Schlüsselwörter

Chronisch-entzündliche Darmerkrankungen - Spondyloarthritis - extraintestinale Manifestationen - Colitis ulcerosa - M. Crohn

Keywords

Inflammatory bowel disease - spondyloarthritis - extra-intestinal manifestations - ulcerative colitis - Crohn´s disease

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