[Spondylarthritides].
Ankylosing spondylitis (AS) is the major subtype and a major outcome of an interrelated group of rheumatic diseases now named as spondyloarthritides (SpA). The most important clinical features of this group are inflammatory back pain (IBP), asymmetric peripheral oligoarthritis, predominantly of the lower limbs, and enthesitis. Established classification criteria for AS and SpA are known to perform less well in early disease stages. This partly contributes to the delay in diagnosis, mainly due the high frequency of back pain in the population. The methods for making an early diagnosis have recently improved. The major factors involved in this improvement are HLA B27 and magnetic resonance imaging of the sacroiliac joints, but also of the spine. Conventional radiography, however, is still the gold standard. International recommendations for the management of AS have recently been published. Conventional medical treatment is based mainly on the use of non-steroidal anti-inflammatory agents (NSAIDs); patients with peripheral arthritis may be treated with sulfasalazine. Patients with persistently active disease benefit from therapy with anti-TNF agents. Physiotherapy is of major importance in the general approach to patients with SpA, especially with AS.
Braun
J
J
Abteilung für Gastroenterologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin. J.Braun@rheumazentrum-ruhrgebiet.de
Sieper
J
J
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D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D015796:HLA-B27 Antigen; D007074:Immunoglobulin G; D007555:Isoxazoles; D018124:Receptors, Tumor Necrosis Factor; D012460:Sulfasalazine; D000069285:Infliximab; D000068879:Adalimumab; D000077339:Leflunomide; D000068800:Etanercept; D008727:Methotrexate