Entzündung und Knochenaufbau

Zusammenfassung

Der Morbus Bechterew (Spondylitis ankylosans), der Prototyp der Spondyloarthritiden, ist durch Entzündungen im Bereich des Achsenskeletts gekennzeichnet. Hauptsymptom ist der entzündliche Rückenschmerz; zusätzlich können periphere Gelenksymptome auftreten. Im Verlauf der Erkrankung kann es zu einer Verknöcherung vorwiegend der Sakro - iliakalgelenke und der Wirbelsäule kommen. Besonders die Bildung von Syndesmophyten im Bereich der Wirbelsäule führt zu einer irreversiblen Funktionsbeeinträchtigung. Ziel ist es daher, die Erkrankung schon in frühen Stadien zu erkennen und zu behandeln. Das Vorhandensein struktureller Schäden in der Wirbelsäule, aber auch eine hohe entzündliche Aktivität sind wichtige Prädiktoren für das Fortschreiten der aberranten Knochenneubildung. Andererseits kann eine zweijährige TNF- α-Inhibitor-Therapie, die effektiv Schmerzen und Entzündung verbessert, die Progression der Knochenneubildung nicht stoppen, was für eine Entkopplung von Entzündung und Gelenk umbau spricht. Im Gegensatz dazu scheint eine kontinuierliche Therapie mit nichtsteroidalen Antirheumatika den Progress der Knochenneubildung bei Spondylitis ankylosans zu verlangsamen, was für eine besondere Bedeutung der Prostaglandine für den Gelenk - umbau bei dieser Erkrankung spricht.

Summary

Morbus Bechterew (ankylosing spondylitis), the prototype of the spondyloarthritides, is characterized by inflammation within the axial skeleton. The main symptom is inflammatory back pain. Apart from that patients can present with peripheral joint symptoms. Ankylosis of sacroiliac joints and of the spine can occur throughout the course of the disease. Irreversible loss of functionality is primarily caused by the development of syndesmophytes within the spine. Therefore, it is a major aim to recognize the disease at early stages to start early treatment. Preexisting structural damage and an enhanced inflammatory activity are important predictors of subsequent progression of structural damage. However, a two year treatment with TNF-α-inhibitors cannot stop progression of new bone formation while being effective in improving pain and inflammation. This suggests disengagement of inflammation and joint remodelling in ankylosing spondylitis. Continuous treatment with non-steroidal anti-inflammatory drugs, however, seems to retard this process which suggests a specific impact of prostaglandins in the joint remodelling process in ankylosing spondylitis.

Schlüsselwörter

Axiale Spondyloarthritis - ankylosierende Spondylitis - Knochenneubildung - Syndesmophyten

Keywords

Axial spondyloarthritis - ankylosing spondylitis - osteoproliferation - syndesmophytes

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