[Pathogenesis of spondylarthritis : Relevance for treatment]

Sehnenpathologien im Bereich des Fußes – Inflammation versus Degeneration: wo liegen die Unterschiede?

Die Ursachen für Tendopathien bzw. Tenosynovialitiden sind mannigfaltig. Stoffwechsel und Genaktivität der Bindegewebszellen im Sehnengewebe reagieren sehr empfindlich auf mechanische Beanspruchung und aber auch entzündliche Reize im Hinblick auf die Integrität der extrazellulären Matrix. Hierin unterscheiden sich entzündliche und degenerative Sehnenerkrankungen nicht. Die verbesserten medikamentösen Möglichkeiten einer nachhaltigen Entzündungskontrolle erlaubt es dem Rheumaorthopäden auch häufiger sich an den fusschirurgischen Prinzipien eines Gelenkerhaltes orientieren zu können. Weiterhin erfordert jedoch die mit chronisch degenerativen Prozeßen nicht vergleichbare Entzündungsintensität einen ausreichenden Erfahrungsschatz im peri- und intraoperativen Umganges mit den RA, SpA und PsA Patienten.

[Spondyloarthritis in childhood and adulthood]

Axial spondylarthritis in adulthood (SpAA) is frequently initially manifested as a sacroiliitis, whereas this not true for enthesitis-related arthritis (EAA), which begins in childhood and adolescence. Classically, EAA begins with peripheral arthritis and only a part transitions into a juvenile SpA (jSpA) or SpAA. The criteria used for classification of SpAA and EAA are currently being validated and revised. For the first time imaging is included for EAA. For both diseases nonsteroidal anti-inflammatory drugs (NSAID) are initially used therapeutically, followed by biologicals or synthetic targeted disease-modifying drugs in refractory courses. Steroids should be avoided in long-term treatment. For optimal transition and further care in adulthood, a close cooperation between internistic and pediatric rheumatologists is necessary.

New insights into IL-17/IL-23 signaling in ankylosing spondylitis (Review)

Ankylosing spondylitis (AS) is a progressive common autoimmune inflammatory disease, part of the spondylarthritis group, characterized, besides clinical spinal and peripheral joint inflammation, by enthesitis and new bone formation, that can lead to severe functional impairment. Beyond intensive and continuous research on the pathogenic process extensively performed in recent years, their impact on therapeutic management remains open to future development. Better knowledge of AS pathogenesis have shown results progressively and studies are being performed to advance our current understanding of the disease. It is well known that tumor necrosis factor (TNF) exerts a central role, along with interleukin-17 (IL-17) and interleukin-23 (IL-23), demonstrated by several clinical studies. Similar to other rheumatic inflammatory conditions, SA is associated with an early process of systemic bone loss, both trabecular and cortical, consecutive osteopenia, osteoporosis, and high fracture risk. Current personalized therapeutic options benefit from new published data, to prevent future complications and to improve quality of life.