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DOI: 10.1055/a-1004-3306
Management – medikamentöse und nicht-medikamentöse Therapie der axialen Spondyloarthritis
Management: Medical and Non-medical Therapy of Axial SpondyloarthritisPublication History
Publication Date:
15 October 2019 (online)
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Zusammenfassung
Der Begriff axiale Spondyloarthritis umfasst sowohl Patienten mit schon vorhandenen Röntgenveränderungen in den Sakroiliakalgelenken oder der Wirbelsäule als auch Patienten in der früheren rein entzündlichen Phase ohne strukturelle Knochenveränderungen. Die Grundlagen der Therapie sind physikalische Therapie und nicht-steroidale Antirheumatika, konventionelle DMARDs spielen im therapeutischen Vorgehen keine Rolle. Die klinische Krankheitsaktivität wird gemessen mit zusammengesetzten Scores, dem BASDAI und dem ASDAS, wobei letzterer außer ‚patient reported outcome‘ – Parametern auch das CRP enthält. Sind Patienten weiterhin aktiv trotz konventioneller Therapie, kommen Biologika zum Einsatz, TNF-Blocker oder IL-17-Inhibitoren. Im Gegensatz zu anderen chronisch-entzündlichen Erkrankungen haben sich andere bisher getestete Biologika als ineffektiv erwiesen, JAK-Inhibitoren könnten eine weitere Therapiemöglichkeit für die Zukunft darstellen. Zur Zeit lässt sich nicht voraussagen, welche axSpA Patienten auf welches Biologikum besser ansprechen.
Abstract
The term axial spondyloarthritis covers both patients with X-ray changes in the sacroiliac joints or spine and patients in the earlier, purely inflammatory stage without structural changes in the bone. Treatment is based on physical therapy and non-steroidal anti-inflammatory drugs, while conventional DMARDs are not effective for axial manifestations. Clinical disease activity is measured by composite scores such as the BASDAI and the ASDAS, the latter containing the CRP level in addition to patient-reported outcome parameters. If patients are still active despite conventional therapy, there is an indication for biologics such as TNF blockers or Il-17 inhibitors. In contrast to other chronic inflammatory diseases, other tested biologics are ineffective for axial spondyloarthritis. JAK inhibitors might be another treatment option for the future. Currently it is not possible to predict which patient responds to which biologic.
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