Spondyloarthritis
The spondyloarthritis (including ankylosing spondylitis or spondyloarthropathy , abbreviated SpA ) is an inflammatory disease of the spine and joints. Five rheumatic diseases are summarized as spondyloarthritis due to similar genetics and symptoms :
- ankylosing spondylitis (synonym: ankylosing spondylitis)
- reactive arthritis (after infection)
- Psoriatic arthritis (associated with psoriasis )
- enteropathic arthritis (for Crohn's disease , ulcerative colitis , Whipple 's disease , and other chronic bowel diseases)
- undifferentiated spondyloarthritis (transitional forms)
As with all inflammatory rheumatic diseases, these are autoimmune diseases : joints are inflamed ( arthritis , arthro- from ancient Greek ἄρθρον arthron , German 'joint' ) without being infected by a pathogen . The eponymous vertebral joints (spondylo- from ancient Greek σπὁνδυλος spondylos , German 'vertebrae' ) can be affected in all diseases mentioned; however, this symptom is only typical of ankylosing spondylitis. In addition to joints, tendons , ligaments , skin and eyes can become inflamed. Spondyloarthritis has a prevalence of around 1% in Europe . In contrast to many other autoimmune diseases, both sexes are affected about equally often.
terminology
Spondyloarthropathy is the generic term for all chronic joint diseases of the spine; In addition to inflammatory spondylarthritis, this also includes the much more common degenerative spondylarthroses . In the English-speaking world, the distinction between inflammatory arthritis on the one hand and non-inflammatory osteoarthritis on the other hand is unusual; The spondyloarthritis treated in this article are therefore mostly referred to as (seronegative) spondyloarthropathies .
Laboratory findings
Patients with spondyloarthritis often have the genetic variant HLA-B27 . The rheumatoid factor is not higher than in the normal population, ie mostly negative ("seronegative"). General inflammation markers such as ESR and CRP can be elevated when the disease is active .
Guiding symptoms
Depending on whether complaints of the back (the axial skeleton ) or the arms and legs (the peripheral joints) predominate, one speaks of an axial or a peripheral spondyloarthritis. By definition, ankylosing spondylitis always takes the form of axial spondyloarthritis. Axial spondyloarthritis is increasingly used as a diagnostic designation, as ankylosing (stiffening) often no longer accurately describes the disease thanks to better therapy and the detection of other forms of disease.
Oligoarthritis
While rheumatoid arthritis typically affects many joints distant from the trunk symmetrically (polyarthritis) , but always spares the finger and toe joints , in spondyloarthritis fewer and larger joints are affected (oligoarthritis) , often the knee joint. Fingers can be in the beam , i. H. be affected with all three joints, from which the picture of the "sausage finger" (dactylitis) results.
Inflammatory back pain
Inflammatory back pain shows a characteristic diurnal course with increased pain during sleep, morning stiffness and improvement over the course of the day. Those affected sometimes wake up in the second half of the night and experience relief by walking around. The symptoms respond well to anti-inflammatory pain relievers (such as ibuprofen), but do not improve for months. Back pain that starts suddenly, is accompanied by neurological deficits or does not appear until the age of 40, on the other hand, is not to be rated as inflammatory but as degenerative (“wear and tear”). The inflammation of the sacroiliac joints ( sacroiliitis ) and vertebral arch joints (spondylarthritis) underlying inflammatory back pain can best be detected in the early stages by magnetic resonance imaging . If damage has already occurred, it can be easily visualized in conventional X-rays .
Further
Inflammation of the tendons occurs in the area of the bone attachments ( enthesopathy ) , most often on the Achilles tendon . If inflammation of the middle skin of the eye ( uveitis anterior) occurs, this must be treated immediately. The involvement of internal organs is rare.
therapy
In milder cases, anti-inflammatory pain relievers ( NSAIDs ) may be sufficient. In more severe cases, the (temporary) use of glucocorticoids such as prednisolone may be indicated; injections into the joint may be possible instead. As DMARDs for long-term preservation of inflammation freedom, among other suitable sulfasalazine and TNF blockers .
literature
- Rudolf Puchner: Rheumatology from Practice. Inflammatory joint diseases - with case studies . Springer-Verlag, Berlin 2017, ISBN 978-3-662-53569-1 , pp. 42 , doi : 10.1007 / 978-3-662-53569-1 ( books.google.com ).
Web links
- Diagnostic Manual of the Assessment of SpondyloArthritis International Society (ASAS)
