Procházková Leona, Červeňák Vladimír, Souček Miroslav
Vnitr Lek. 2018 Spring;64(2):108-116.
Axial spondyloarthritis (axSpA) is a common name for the non-radiographic form of the disease and radiographic axial spondyloarthritis, known as ankylosing spondylitis (AS). The disease is typically manifested at a young age, characterized by affection of axial skeleton, and in the most severe form can lead to complete ankylosis of the spine. Etiology of diseases have not yet been clarified, however, the genetic background, especially the binding to HLA-B27 antigen, is obvious. Clinical manifestations are dominated by chronic pain in the lower pain or buttocks that occurred in young age, in a large proportion of patients having the character of so-called inflammatory pain. In addition to the axial skeleton, axSpA there is also common affection of peripheral skeleton in the form of enthesitis, arthritis, and less often dactylitis. At present, enthesitis is considered as a hallmark of the entire spondyloarthritis group. Typical for axSpA is the frequent presence of extraskeletal manifestations in the form of uveitis, idiopathic intestinal inflammation and psoriasis. In the axSpA diagnosis, significant advances have been made in recent years in the field of imaging techniques. Magnetic resonance imaging can also identify the early stage of the disease before the development of structural lesions. Also, the newer concepts of the entire spondyloarthritis group, based on the 2009 ASAS (Assessment of SpondyloArthritis international Society) classification criteria, contributed to early diagnosis of the disease, and in particular to the underlying importance of association with HLA-B27 antigen and the presence of peripheral and non-articular manifestations. Non-steroidal anti-rheumatic drugs (NSAIDs) and TNFα blockers are effective axSpA therapy, which has been recently enhanced by interleukin 17 blockade (IL17).Key words: axial spondyloarthritis - biological treatment - enthesitis - extraarticular manifestations - magnetic resonance imaging - non-radiographic axial spondyloarthritis - sacroiliitis.
轴性脊柱关节炎（axSpA）是该疾病非放射学形式和放射学轴性脊柱关节炎（即强直性脊柱炎，AS）的统称。该病通常在年轻时发病，以中轴骨骼受累为特征，最严重时可导致脊柱完全强直。疾病的病因尚未明确，不过，遗传背景，尤其是与HLA - B27抗原的关联很明显。临床表现以年轻时出现的下背部或臀部慢性疼痛为主，大部分患者的疼痛具有所谓的炎性疼痛特征。除了中轴骨骼，axSpA还常以外周骨骼附着点炎、关节炎的形式累及外周骨骼，指（趾）炎则较少见。目前，附着点炎被视为整个脊柱关节炎组的标志。axSpA的典型特征是常伴有葡萄膜炎、特发性肠道炎症和银屑病等关节外表现。在axSpA的诊断方面，近年来成像技术领域取得了重大进展。磁共振成像还可在结构病变出现之前识别疾病的早期阶段。此外，基于2009年脊柱关节炎国际协会（ASAS）分类标准的整个脊柱关节炎组的新观念有助于疾病的早期诊断，尤其是与HLA - B27抗原关联以及外周和非关节表现的潜在重要性。非甾体类抗风湿药物（NSAIDs）和肿瘤坏死因子α阻滞剂是有效的axSpA治疗方法，近年来白细胞介素17阻断（IL17）疗法进一步增强了治疗效果。关键词：轴性脊柱关节炎 - 生物治疗 - 附着点炎 - 关节外表现 - 磁共振成像 - 非放射学轴性脊柱关节炎 - 骶髂关节炎
