Spondyloarthritides - Clinical manifestation,classification criteria and therapy concept

摘要

Spondyloarthritides (SpA) are a group of inflammatory rheumatic diseases that are differentiated by either the principle clinical manifestations or according to subtypes. The most important subtype is ankylosing spondylitis (AS). The other subtypes are SpA with psoriasis, after previous infections (ReA), associated with chronic inflammatory bowel diseases (SpACED) and, above all, peripheral undifferentiated SpA (uSpA). The most important symptoms of SpA are inflammatory back pain and peripherally, usually asymmetric oligoarthritis and enthe; sitis. The strongest genetic factor, HLA B27, is present in ca. 90% of the AS patients. Further genetic factors were identified just recently: ERAP-1 and 1L23R as well as IL-1 polymorphisms in part show a strong association to SpA. The conventional drug recommendations consist mainly of non;steroidal anti;rheumatics (NSAR), a therapeutic trial with sulfasalazine is justified, especially for patients with peripheral arthritis. Patients with persisting elevated inflammatory activity profit from therapy with TNF blockers. Physiotherapy is of major significance for the general treatment approach in SpA, above all those with ankylosing spondylitis.