Beurteilung schwerer Verlaufsformen von Spondyloarthritiden

U. Kiltz; F. Heldmann; X. Baraliakos; J. Braun

doi:10.1055/s-0037-1617967

Arthritis und Rheuma, Table of Contents

Arthritis und Rheuma 2014; 34(01): 15-22
DOI: 10.1055/s-0037-1617967

Rheumatische Erkrankungen mit schwerem Verlauf

Schattauer GmbH

Beurteilung schwerer Verlaufsformen von Spondyloarthritiden

Welche Parameter können hilfreich sein?Assessment of severity in spondyloarthritisWhich parameters can be helpful?

U. Kiltz

¹Rheumazentrum Ruhrgebiet, Herne

,

F. Heldmann

¹Rheumazentrum Ruhrgebiet, Herne

,

X. Baraliakos

¹Rheumazentrum Ruhrgebiet, Herne

,

J. Braun

¹Rheumazentrum Ruhrgebiet, Herne

› Author Affiliations

Abstract

Zusammenfassung

Patienten mit axialer und peripherer Spondyloarthritis (SpA) haben variable Krankheitsverläufe, bei denen neben muskuloskelettalen Manifestationen auch extraskelettale Manifestationen den Schweregrad der Erkrankung beeinflussen können. Bei der Analyse des Schweregrades einer SpA müssen neben Krankheitsaktivität auch Funktion, Wirbelsäulenbeweglichkeit und strukturelle Veränderungen erfasst und quantifiziert werden. Sowohl entzündliche als auch strukturelle Veränderungen können unabhängig voneinander zu Einschränkungen der körperlichen Funktionsfähigkeit führen. Die genannten und einige andere Variablen können zur Charakterisierung des Schweregrades einer SpA herangezogen werden. Eine allgemeingültige Graduierung oder Definition des Schweregrads einer SpA existiert aktuell aber noch nicht. Der kürzlich entwickelte ASAS-Gesundheitsindex kann prinzipiell für solche Fragestellungen verwendet werden.

Summary

Patients with axial and peripheral spondyloarthritis (SpA) may have different and variable disease courses. Muskuloskelettal and extraskelettal manifestations may contribute to the severity of the disease. When assessing severity in patients with SpA, one should assess disease activity, function, spinal mobility and structural progression in patients with SpA. Inflammation and new bone formation are independent contributors to reduced physical functioning of patients with SpA. These and other variables can be used to asses disease severity in patients with SpA, but a generalised definition about severity in patients with SpA has not been agreed upon to date. The recently developed ASAS health index could become an option in this regard.

Schlüsselwörter

Schweregrad einer Spondyloarthritis - körperliche Funktionsfähigkeit - radiologische Progression - ASAS-Gesundheitsindex

Keywords

Severity of spondyloarthritis - physical functioning - radiographic progression - ASAS health index

Full Text

References

Literatur
1 Francois RJ, Eulderink F, Bywaters EG. Commented glossary for rheumatic spinal diseases, based on pathology. Ann Rheum Dis 1995; 54 (08) 615-625.
2 Braun J, Sieper J. Ankylosing spondylitis. Lancet 2007; 369 (9570): 1379-1390.
3 Rudwaleit M. et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68 (06) 777-783.
4 Rudwaleit M. et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70 (01) 25-31.
5 van Tubergen A. et al. Assessment of fatigue in patients with ankylosing spondylitis: a psychometric analysis. Arthritis Rheum 2002; 47 (01) 8-16.
6 Ward MM. Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res 1999; 12 (04) 247-255.
7 Appel H, Rudwaleit M, Sieper J. Relevance of osteoproliferation as an outcome parameter in ankylosing spondylitis. Nat Clin Pract Rheumatol 2008; 4 (11) 578-579.
8 Landewe R. et al. Physical function in ankylosing spondylitis is independently determined by both disease activity and radiographic damage of the spine. Ann Rheum Dis 2009; 68 (06) 863-867.
9 Van der Cruyssen B. et al. Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery. Rheumatology (Oxford) 2010; 49 (01) 73-81.
10 Van der 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 (08) 1072-1077.
11 Ward MM. et al. Risk factors for functional limitations in patients with long-standing ankylosing spondylitis. Arthritis Rheum 2005; 53 (05) 710-717.
12 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 (03) 613-622.
13 Creemers MC. et al. Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis 2005; 64 (01) 127-129.
14 Poddubnyy D. et al. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis 2011; 70 (08) 1369-1374.
15 Poddubnyy D. et al. Cigarette smoking has a dose-dependent impact on progression of structural damage in the spine in patients with axial spondyloarthritis: results from the GErman SPondyloarthritis Inception Cohort (GESPIC). Ann Rheum Dis 2013; 72 (08) 1430-1432.
16 Chung HY. et al. Smokers in early axial spondyloarthritis have earlier disease onset, more disease activity, inflammation and damage, and poorer function and health-related quality of life: results from the DESIR cohort. Ann Rheum Dis 2012; 71 (06) 809-816.
17 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 (05) 1388-1398.
18 Poddubnyy D. et al. Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort. Ann Rheum Dis 2012; 71 (10) 1616-1622.
19 Doran MF. et al. Predictors of longterm outcome in ankylosing spondylitis. J Rheumatol 2003; 30 (02) 316-320.
20 Calin A. et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 1994; 21 (12) 2281-2285.
21 Chandran V. et al. Relationship between spinal mobility and radiographic damage in ankylosing spondylitis and psoriatic spondylitis: a comparative analysis. J Rheumatol 2007; 34 (12) 2463-2465.
22 Jenkinson TR. et al. Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 1994; 21 (09) 1694-1698.
23 Garrett S. et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994; 21 (12) 2286-2291.
24 van der Heijde D. et al. 2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis. Ann Rheum Dis 2011; 70 (06) 905-908.
25 van der Heijde D. et al. ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis 2009; 68 (12) 1811-1818.
26 Spoorenberg A. et al. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 1999; 26 (04) 980-984.
27 Rudwaleit M. et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 2009; 68 (10) 1520-1527.
28 Bennett AN. et al. Severity of baseline magnetic resonance imaging-evident sacroiliitis and HLA-B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years. Arthritis Rheum 2008; 58 (11) 3413-3418.
29 Hermann KG. et al. Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI study group. Ann Rheum Dis 2012; 71 (08) 1278-1288.
30 Rudwaleit M. et al. MRI in predicting a major clinical response to anti-tumour necrosis factor treatment in ankylosing spondylitis. Ann Rheum Dis 2008; 67 (09) 1276-1281.
31 Sieper J. et al. Persistent reduction of spinal inflammation as assessed by magnetic resonance imaging in patients with ankylosing spondylitis after 2 yrs of treatment with the anti-tumour necrosis factor agent infliximab. Rheumatology (Oxford) 2005; 44 (12) 1525-1530.
32 van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27 (04) 361-368.
33 Baraliakos X. et al. The natural course of radiographic progression in ankylosing spondylitis - evidence for major individual variations in a large proportion of patients. J Rheumatol 2009; 36 (05) 997-1002.
34 Braun J. et al. Staging of patients with ankylosing spondylitis: a preliminary proposal. Ann Rheum Dis 2002; 61 (Suppl. 03) iii9-iii23.
35 Klingberg E. et al. Osteoporosis in ankylosing spondylitis - prevalence, risk factors and methods of assessment. Arthritis Res Ther 2012; 14 (03) R108.
36 Vosse D. et al. Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis 2009; 68 (12) 1839-1842.
37 Braun J. et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011; 70 (06) 896-904.
38 van Echteld I. et al. Identification of the most common problems by patients with ankylosing spondylitis using the international classification of functioning, disability and health. J Rheumatol 2006; 33 (12) 2475-2483.
39 Sigl T. et al. ICF based comparison of disease specific instruments measuring physical functional ability in ankylosing spondylitis. Ann Rheum Dis 2005; 64 (11) 1576-1581.
40 Kiltz U. et al. Developing and validating an index for measuring health in patients with ankylosing spondylitis. Rheumatology (Oxford) 2011; 50 (05) 894-898.
41 Boonen A. et al. ASAS/WHO ICF Core Sets for ankylosing spondylitis (AS): how to classify the impact of AS on functioning and health. Ann Rheum Dis 2010; 69 (01) 102-107.
42 Kiltz U. et al. Development of a health index in patients with ankylosing spondylitis (ASAS HI): final result of a global initiative based on the ICF guided by ASAS. Ann Rheum Dis. 2014 Jan 7. doi: [Epub ahead of print]