Rudwaleit M
Klinik für Innere Medizin und Rheumatologie, Klinikum Bielefeld Rosenhöhe, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland.
Internist (Berl). 2017 Jul;58(7):687-701. doi: 10.1007/s00108-017-0263-7.
Spondyloarthritides (SpA) are inflammatory rheumatic diseases affecting the axial skeleton, peripheral joints and entheses, and also manifest at extraskeletal sites. According to the more recently introduced nomenclature, predominant axial SpA is distinguished from predominant peripheral SpA. Axial SpA is further divided into radiographic and nonradiographic axial SpA. Genetic factors are relevant, with HLA-B27 being most important. The interleukin 23/17 pathway seems to be relevant and points towards new therapeutic targets. Inflammatory back pain is the leading symptom in axial SpA and has certain characteristics. In addition, HLA-B27 and sacroiliitis on imaging are important for diagnosis. Therapy consists of physiotherapy, nonsteroidal anti-inflammatory drugs (first line) and biologicals (second line). Conventional disease-modifying antirheumatic drugs are effective only in peripheral arthritis.
脊柱关节炎(SpA)是一类影响中轴骨骼、外周关节和附着点的炎性风湿性疾病,也可在骨骼外部位出现症状。根据最近采用的命名法,主要累及中轴的SpA与主要累及外周的SpA有所区分。中轴SpA又进一步分为影像学阳性中轴SpA和影像学阴性中轴SpA。遗传因素与之相关,其中HLA-B27最为重要。白细胞介素23/17通路似乎也与之相关,并指向新的治疗靶点。炎性腰背痛是中轴SpA的主要症状,具有一定特征。此外,HLA-B27及影像学显示的骶髂关节炎对诊断很重要。治疗方法包括物理治疗、非甾体抗炎药(一线治疗)和生物制剂(二线治疗)。传统的改善病情抗风湿药物仅对外周关节炎有效。