Braun J, Kiltz U, Baraliakos X, van der Heijde D
Rheumazentrum Ruhrgebiet, Herne, Germany.
Clin Exp Rheumatol. 2014 Sep-Oct;32(5 Suppl 85):S-96-104. Epub 2014 Oct 30.
The spondyloarthritides (SpA) are currently differentiated into axial and peripheral SpA. Patients with axial SpA (axSpA) may be further classified into the classical form ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA). The SpA are genetically linked, and the subtypes including psoriatic arthritis (PsA) share characteristic clinical symptoms such as inflammatory back pain (IBP) and enthesitis. IMP can be due to sacroiliitis and spondylitis, enthesitis may occur with or without arthritis, and anterior uveitis, as well as other extraarticular manifestations such as psoriasis and chronic inflammatory bowel disease (IBD). In addition to clinical findings, imaging, mainly conventional radiography and magnetic resonance imaging (MRI), and laboratory results such as HLA B27 and CRP are important tools for classification and diagnosis of SpA. The Assessment of SpondyloArthritis international Society (ASAS), an international group of experts in the field of SpA since 1995, has published on assessments and outcome parameters in SpA. The publication of classification criteria for axSpA has now largely replaced the 1984 criteria for AS. However, the established cut-off between AS and nr-axSpA, 'definite' structural changes in the sacroiliac joints, has been recently debated because of limited reliability. Since imaging plays an important role in all criteria sets, the ASAS group has recently published definitions for inflammatory changes in the SIJ and the spine. The most important domains in AS are disease activity, function, spinal mobility, structural damage, and quality of life, some of which are discussed in this manuscript. For axSpA there are two major tools to assess disease activity, the BASDAI and the ASDAS, one for function, the BASFI, and several mobility measures including the BASMI. The AS Health Index (AS-HI) is introduced elsewhere in this supplement.
脊柱关节炎(SpA)目前分为轴性SpA和外周性SpA。轴性SpA(axSpA)患者可进一步分为典型的强直性脊柱炎(AS)和非放射学axSpA(nr-axSpA)。SpA存在遗传关联,包括银屑病关节炎(PsA)在内的各亚型具有诸如炎性背痛(IBP)和附着点炎等特征性临床症状。炎性腰背痛可能由骶髂关节炎和脊柱炎引起,附着点炎可伴或不伴关节炎出现,还可出现前葡萄膜炎以及其他关节外表现,如银屑病和慢性炎症性肠病(IBD)。除临床检查结果外,影像学检查(主要是传统X线摄影和磁共振成像(MRI))以及实验室检查结果(如HLA B27和CRP)是SpA分类和诊断的重要工具。自1995年起,国际脊柱关节炎评估协会(ASAS)作为SpA领域的一个国际专家组织,已发表了关于SpA评估和结局参数的文章。axSpA分类标准的发布现已在很大程度上取代了1984年的AS标准。然而,由于可靠性有限,AS与nr-axSpA之间既定的界限,即骶髂关节“明确”的结构改变,最近受到了质疑。由于影像学在所有标准组中都起着重要作用,ASAS小组最近发布了骶髂关节和脊柱炎性改变的定义。AS中最重要的领域是疾病活动度、功能、脊柱活动度、结构损伤和生活质量,本文将对其中一些内容进行讨论。对于axSpA,有两种主要的疾病活动度评估工具,即BASDAI和ASDAS,一种功能评估工具BASFI,以及包括BASMI在内的几种活动度测量方法。本增刊其他地方介绍了AS健康指数(AS-HI)。