Skip to main content
SpringerLink
Log in

Entzündliche Wirbelsäulenerkrankungen als Ursache für Rückenschmerzen

Inflammatory spine disease as a cause of back pain

  • Rückenschmerz: Diagnostik und Intervention
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Zielsetzung

Ziel der Arbeit ist, die Bedeutung inflammatorischer Wirbelsäulenerkrankungen für das Leitsymptom Rückenschmerz zu erörtern. Die Aussagekraft der verschiedenen radiologischen Verfahren wird diskutiert.

Material und Methoden

Basierend auf der Einteilung der seronegativen Spondylarthropathien (SpA) sowie der rheumatoiden Arthritis (RA), erfolgte eine systematische Literaturrecherche. Die Ergebnisse dieser Recherche und die eigenen Erfahrungen mit einem großen rheumatologischen Krankengut werden analysiert.

Ergebnisse

Die Prävalenz der RA (1–2%) und der Gruppe der SpA (1,9%) ist vergleichbar, wobei die Ätiologie letztlich bei keiner der genannten Erkrankungen bekannt ist. Die bildmorphologische Kriterien können sich überlappen. Die MRT wird zunehmend bei Früherkennung und Verlaufsbeurteilung der immunmodulatorischen Therapien (TNF-α-Antagonisten) eingesetzt.

Diskussion

Ein Ödem im Knochen, das nur mit der MRT nachweisbar ist, zeigt die Aktivität der Entzündung bereits im frühen Stadium. Der Einsatz von TNF-α-Antagonisten wird neben klinischen und laborchemischen Kriterien zunehmend von den Zeichen der Floridität in der MRT abhängig gemacht. Das Ansprechen oder Versagen einer medikamentösen Therapie kann mit der MRT bewertet werden.

Abstract

Purpose

The aim of this review is to evaluate the role of inflammatory spine disease in patients with chronic back pain. The contribution of imaging modalities for the diagnostic evaluation of back pain is discussed.

Material and methods

A systematic literature search based on the classification of seronegative spondyloarthropathies and rheumatoid arthritis was performed. The results of this search and the experiences in a large collective of rheumatological patients are analyzed.

Results

The prevalence of rheumatoid arthritis (1–2%) is comparable to that of spondyloarthropathies (1.9%). The etiology of these entities is not fully elucidated. Magnetic resonance imaging is increasingly used for early detection and surveillance of therapy with TNF-α antagonists.

Discussion

Bone marrow edema, which is only detectable with MRI, represents an early sign of inflammation. Therapy with TNF-α antagonists is based on clinical and laboratory criteria, and signs of inflammation in MRI. MRI is useful for assessment of the effectiveness of anti-inflammatory therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1 a
Abb. 2
Abb. 3a,b
Abb. 4
Abb. 5
Abb. 6a,b
Abb. 7a,b
Abb. 8a,b
Abb. 9
Abb. 10
Abb. 11a-c

Literatur

  1. Antoni C, Dechant C, Lorenz PD et al. (2002) Open-label study of infliximab treatment for psoriatic arthritis: clinical and magnetic resonance imaging measurements of reduction of inflammation. Arthritis Rheum 47: 506–512

    Article  PubMed  Google Scholar 

  2. Baraliakos X, Davis J, Tsuji W, BraunJ (2005) Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis before and after therapy with the tumor necrosis factor α receptor fusion protein etanercept. Arthritis Rheum 52(4): 1216–1223

    Article  PubMed  Google Scholar 

  3. Barraclough D, Russel AS, Percy JS (1977) Psoriatric spondylitis: a clinical, radiological, and scintiscan survey. J Rheumatol 4(3): 282–287

    PubMed  Google Scholar 

  4. Battistone MJ, Manaster BJ, Reda DJ et al. (1999) The prevalence of sacroiliitis in psoriatic arthritis: New perspectives from a large, multicenter cohort. Skeletal Radiol 28: 196

    Article  PubMed  Google Scholar 

  5. Boden SD, Dodge LD, Bohlmann HH, Rechtine GR (1993) J Bone Joint Surg 75-A: 1282–1297

    Google Scholar 

  6. Bollow M, Braun J (2002) Sakroiliakalgelenk. In: Vahlensieck M, Reiser M (Hrsg) MRT des Bewegungsapparats. Thieme, Stuttgart New York, S 477–522

  7. Bollow M, Braun J, Taupitz M et al. (1996) CT-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with spondyloarthropathy: indication and follow-up with contrast-enhanced MRI. J Comp Assist Tomogr 20(4): 512–521

    Article  Google Scholar 

  8. Braun J, Bollow M, Seyrekbasan F et al. (1996) Computed tomography guided corticosteroid injection of the sacroiliacal jont in patients with spondylarthropathy with sacroiliitis: clinical outcome and followup by dynamic magnetic resonance imaging. J Rheumatol 23: 659–664

    PubMed  Google Scholar 

  9. Brown MA, Kennedy LG, Mac Gregor AJ et al. (1997) Susceptibility to ankylosing spondylitits in twins: the role of the genes, HLA, and the environment. Arthritis Rheum 40: 1823–1828

    PubMed  Google Scholar 

  10. Bundschuh C, Modic MT, Kearny F et al. (1988) Rheumatoid arthritis of the cervical spine. Am J Roentgenol 151: 181–187

    Google Scholar 

  11. Delamarter RB, Bohlmann HH (1994) Postmortem osseus and neuropathologic analysis of the rheumatoid cervical spine. Spine 19: 2267–2274

    PubMed  Google Scholar 

  12. Fassbender HG (1994) Inflammatory reactions in arthritis. In: Davies ME, Dingle JT (eds) Immunopharmacology of joints and connective tissue. Academic Press, London, pp 165–198

  13. Freyschmidt J, Freyschmidt G (1996) Haut-, Schleimhaut- und Skeletterkrankungen: SKIBO Diseases. Springer, Berlin Heidelberg New York

  14. Freyschmidt J (1997) Skeletterkrankungen, 2. Aufl. Springer, Berlin Heidelberg New York

  15. Fritz J, König CW, Günaydin I et al. (2005) Magnetresonanzgesteuerte Kortikosteroid-Infiltration der Sakroiliakalgelenke: Schmerztherapie der Sakroiliitis bei Patienten mit Spondylitis ankylosans. Fortschr Röntgenstr 177: 555–563

    Google Scholar 

  16. Göttsche T, Kothe R, Adam G, Rüther W (2004): Radiologische Diagnostik der zervikalen rheumatoiden Arthritis. Z Rheumatol 63: 296–302

    PubMed  Google Scholar 

  17. Greenspan A (2003) Skelettradiologie. Teil III: Arthritis, Arthrose, Arthropathie. Urban & Fischer, München Jena

    Google Scholar 

  18. Günaydin I, Pereira PL, Fritz J et al. (2005) Magnetic resonance imaging guided corticosteroid injection of sacroiliac joints in patients with spondylarthropathy. Are multiple injections more beneficial? Rheumatol Int; Epub ahead of print

  19. Healy PJ, Helliwell PS (2005) Classification of the spondylarthropathies. Curr Opin Rheumatol 17: 395–399

    Article  PubMed  Google Scholar 

  20. Hermann K-G, Bollow M (2004) Magentic resonance imaging of the axial skeleton in rheumatoid disease. Clin Rheumatol 18(6): 881–907

    Article  PubMed  Google Scholar 

  21. Jevtic V, Watt I, Rozman B et al. (1995) Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol 24: 351–355

    Article  PubMed  Google Scholar 

  22. Kauppi M, Neva MH (1998) Sensitivity of lateral view cervical spine radiographs taken in the neutral position in atlantoaxial subluxation in rheumatic diseases. Clin Rheumatol 17(6): 511–514

    Article  PubMed  Google Scholar 

  23. Kay-Geert AH, Bollow M (2004) Magnetic resonance imaging of the axial skeleton in rheumatoid disease. Clin Rheumatol 18(6): 881–907

    Article  PubMed  Google Scholar 

  24. Kellner W, Kellner HL, Pfeifer KJ et al. (2000) MR-guided corticosteroid injection into sacroiliac joint in patients with seronegative spondylarthropathy: initial experiences and clinical outcome. Radiology 217: S358–S358

    Google Scholar 

  25. Killebrew K, Gold RH, Sholkoff SD (1973) Psoriatic spondylitis. Radiology 108(1): 9–16

    PubMed  Google Scholar 

  26. Kransdorf MJ, Wehrle PA, Moser RP jr (1988) Atlantoaxial subluxation in Reiter’s syndrome. A report of three cases and review of the literature. Spine 13: 12

    PubMed  Google Scholar 

  27. Moll JMH, Haslock I, Macrae IF et al. (1974) Associations between ankylosing spondylitis, psoriatic arthritis, Reiter’s disease, the intestinal arthropathies, and Behcet’s syndrome. Medicine 53: 343

    PubMed  Google Scholar 

  28. Nash P, Mease PJ, Braun J et al. (2005) Serongeative spondylarthropathies: to lump or split? Ann Rheum Dis 64 [suppl 2]: 9–13

  29. Nguyen HV, Ludwig SC, Silber J et al. (2004) Rheumatoid arthritis of the cervical spine. Spine 4: 329–334

    Article  Google Scholar 

  30. Obermayer-Pietsch BM, Lange U, Tauber G et al. (2003) Vitamin D receptor initiation codon polymorphism, bone density and inflammatory activity of patients with ankylosing spondylitis: a two-year follow-up study. Osteoporosis Int 14: 995–1000

    Article  Google Scholar 

  31. Oda T, Fujiwara K, Yonenobu K et al. (1995) Natural course of cervical spine lesions in rheumatoid arthritis. Spine 20: 1128–1135

    PubMed  Google Scholar 

  32. Oostveen J, Prevo R, den Boer J, van der Laar M(1999) Early detection of sacroiliiitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective longitudinal study. J Rheumatol 26: 1953–1958

    PubMed  Google Scholar 

  33. Pereira PL, Gunaydin I, Trubenbach J et al. (2000) Interventional MR imaging for injection of sacroiliac joints in patients with sacroiliitis. AJR Am J Roentgenol 175: 265–266

    PubMed  Google Scholar 

  34. Rahman P, Gladman DD, Cook RJ et al. (1998) Radiological assessment in psoriatic arthritis. Br J Rheumatol 37: 760–765

    Article  PubMed  Google Scholar 

  35. Redlund-Johnell I, Pettersson H (1984) Radiographic measurements of the craniovertebral region. Designed for evaluation of abnormalities in rheumatoid arthritis. Acta Radiol Diagn 25: 23–28

    Google Scholar 

  36. Reiter MF, Boden SD (1998) Inflammatory disorders of the cervical spine. Spine 23: 2755–2766

    Article  PubMed  Google Scholar 

  37. Resnick D (1989) Inflammatory disorders of the vertebral column: seronegative spondyloarthropathies, adult-onset rheumatoid arthritis, and juvenile chronic arthritis. Clin Imaging 13(4): 253–268

    Article  PubMed  Google Scholar 

  38. Resnick D, Niwayama G (1995) Rheumatoid arthritis. In: Resnick D, Niwayama G (eds) Diagnosis of bone and joint disorders. Saunders, Philadelphia, pp 928–933

  39. Reveille JD, Arnett FC (2005) Spondyloarthritis: update on pathogenesis and management. Am J Medicine 118: 592–603

    Article  Google Scholar 

  40. Roche CJ, Eyes BE, Whitehouse GH (2002) The rheumatoid cervical spine: signs of instability on plain cervical radiographs. Clin Radiol

    Google Scholar 

  41. Romanus R, Yden S (1952) Destructive and ossifying spondylitic changes in rheumatoid ankylosing spondylitis (pelvo-spondylitis ossificans). Acta Orthop Scand 22(2): 88–99

    PubMed  Google Scholar 

  42. Sholkoff SD, Glickman MG, Steinback HL (1970) Roentgenology of Reiter’s syndrome. Radiology 97: 497

    PubMed  Google Scholar 

  43. Sieper J, Braun J, Rudwaleit M et al. (2002) Ankylosing spondylitis: an overview. Ann Rheum Dis 61 [suppl III]: iii8–iii18

  44. Stiskal MA, Neuhold A, Szolar DH et al. (1995) Rheumatoid arthritis of the cranicervical region by MR imaging: detection and characterization. Am J Roentgenol 165: 585–592

    Google Scholar 

  45. Taylor HG, Wardle T, Beswick EJ, Dawes PT (1991) The relationship of clinical and laboratory measurements to radiological change in ankylosing spondylitis. Br J Rheumatol 30: 330–335

    PubMed  Google Scholar 

  46. Totterman SM (2004) Magnetic resonance imaging of psoriatic arthritis: insight from traditional and three-dimensional analysis. Curr Rheumatol Rep 6: 317–321

    PubMed  Google Scholar 

  47. Weldon WV, Scalettar R (1961) Roentgen changes in Reiter’s syndrome. AJR 86: 344

    Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Institut für Klinische Radiologe, Klinikum Innenstadt der Ludwig-Maximilians-Universität, Ziemssenstr. 1, 80336 , München

    T. Schlossbauer, A. Panteleon & C. Becker-Gaab

Authors
  1. T. Schlossbauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Panteleon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Becker-Gaab
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Schlossbauer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schlossbauer, T., Panteleon, A. & Becker-Gaab, C. Entzündliche Wirbelsäulenerkrankungen als Ursache für Rückenschmerzen. Radiologe 46, 468–479 (2006). https://doi.org/10.1007/s00117-006-1387-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-006-1387-2

Schlüsselwörter

Keywords

Search

Navigation