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Frühdiagnose und Verlaufsprädiktoren der ankylosierenden Spondylitis und Spondyloarthritis

Early diagnosis of ankylosing spondylitis and spondyolarthritis and predictors of outome

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Summary

Ankylosing spondylitis (AS) is a relevant differential diagnosis in patients with chronic back pain. Inflammatory back pain is the leading symptom in AS and also in undifferentiated spondyloarthritis. The diagnosis of AS is often delayed by 5 to 10 years, mainly because radiographs do not reveal definite radiographic sacroiliitis during the initial stage of the disease. Diagnostic algorithms based on Bayesian models have been developed to facilitate making an early diagnosis in daily practice. Moreover, screening parameters for early referral to the rheumatologist of patients seen in primary care have been evaluated. Male sex, extraspinal manifestations, and existing syndesmophytes on radiographs appear to be predictors of a worse disease outcome.

Zusammenfassung

Die ankylosierende Spondylitis (AS, Morbus Bechterew) ist eine wichtige Differentialdiagnose bei Patienten mit chronischem Rückenschmerz. Leitsymptom der AS und auch der undifferenzierten Spondyloarthritis ist der entzündliche Rückenschmerz. Die Diagnose einer AS wird oft erst 5–10 Jahre nach Auftreten der ersten Symptomen gestellt, meist weil das Röntgenbild in den Frühstadien keine eindeutige Sakroiliitis zeigt. Zur Verbesserung der Frühdiagnostik sind evidenzbasiert diagnostische Algorithmen entwickelt worden, die dem praktisch tätigen Rheumatologen Sicherheit in der Diagnosestellung geben sollen. Des Weiteren wurden einfache Screening-Parameter vorgeschlagen, die Hilfestellungen zur Überweisung geeigneter Patienten sein sollen. Für die AS prognostisch relevante Faktoren scheinen männliches Geschlecht, extraspinale Manifestationen und im Röntgenbild bereits vorhandene Syndesmophyten an der Wirbelsäule zu sein. Rauchen scheint ebenfalls mit einem schlechteren Krankheitsverlauf der AS einherzugehen.

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Rudwaleit, M. Frühdiagnose und Verlaufsprädiktoren der ankylosierenden Spondylitis und Spondyloarthritis. Wien Med Wochenschr 158, 186–190 (2008). https://doi.org/10.1007/s10354-008-0519-x

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