SUMMARY Fifty patients with ankylosing spondylitis (AS) confined to the spine and sacroiliac joints were compared with 50 cases of AS complicated by various patterns of non-axial joint involvement. Radiological and clinical features were evaluated and HLA-DR4 typing was carried out. This antigen was found in 16% of 200 normal individuals in 18% of patients suffering from exclusively axial AS, and in 54% of patients with additional purely peripheral joint involvement (wrist, finger, ankle, toe). The possibility that HLA-DR4 represents a non-specific marker for peripheral arthritis in patients with ankylosing spondylitis is discussed.
In 93 patients with classical chronic polyarthritis (rheumatoid arthritis) (at least five ARA-criterias) there were inflammatory lesions of dens epistropheus in 48.4%, ventral atlantoaxial subluxations in 25.8%, lateral atlantoaxial dislocations in 14% and pseudobasilary invagination in 5.4%. Step-ladder-subluxation between C 2/C 7 was found in 31.2%, discitis in 12.5% and spondylarthritis in 38% of cases. Inflammatory signs of the cervical spine were correlated to the Steinbrocker-Grade IV, ANA level 1:40 and the degree of Waaler-Rose. The correlation between long standing steroid-therapy and signs of cervical involvement during c.p.--specially in C1/C2--is found to be proven. There are connections between the duration of c.p. (more than 10 years) and manifestation of cervical spine lesions, further, in a protective sense between longstanding gold therapy and cervical spine lesions.
ZusammenfassungDie Spondylitis ankylosans (Sp. a.) ist eine systemisch-entzündli-che Erkrankung der Kreuzdarmbeingelenke, der Wirbelsäule sowie der Sehnen-und Bandansätze. Die ausgeprägte Variabilität der Krankheitsverläufe beinhaltet die ausschließlich die Kreuzdarmbeingelenke involvierende, häufig nur magnetresonanztomographisch objektivierbare Arthritis, aber auch das Vollbild der Bambusstabwirbelsäule. Die überwiegend stammnahen, seltener peripheren Arthritiden und polytop lokalisierte Enthesitiden erweitern das Krankheitsspektrum noch. Unterschiedliche Verläufe münden nach unterschiedlich langen Zeitintervallen in verschieden ausgeprägten destruktiv und proliferativ entstandenen Wirbelsäulen-und Gelenkschäden mit konsekutiven Funktionsdefiziten, begleitet von schmerzreichen oder -ärmeren Phasen. Dieses breite Verlaufsspektrum ist die eigentliche Herausforderung für jede komplexe Rehabilitation. Um sie zu konzipieren, sind Kenntnisse der pathologisch anatomischen Abläu-fe und ihrer pathomechanischen Folgen wichtig. Im Längsschnitt entstandene Schäden münden in einen aktuellen Querschnitt, der vor jeder Rehabilitationsplanung zu objektivieren ist. Diese Bestandsaufnahme ist die Basis des komplexen Rehabilitationskonzepts, das aus einem Bündel unterschiedlicher Maßnahmen besteht. Der folgende Artikel versucht diese Zusammenhänge darzustellen, die einzelnen Rehabilitationsmaßnahmen zu integrieren und die bisher publizierte wissenschaftliche Evidenz der Wirksamkeit eingesetzter physiotherapeutischer Methoden zu bewerten. Schlüsselwörter Ankylosing spondylitis · Arthritis · Enthesitis · Rehabilitation AbstractAnkylosing spondylitis (AS), as a part of the spondyloarthropathies, represents a chronic inflammatory disease of the sacroiliac joints, spine, and the tendinous and ligamentous insertions onto bone. AS may present as arthritis involving shoulder, hip or knee joints and, less commonly, peripheral joints. The extreme variety of the natural course is evidenced by the more or less painful arthritis confined to the sacroiliac joints and the extensive spinal involvement leading to the so-called "bamboo spine." The variable natural course can be complicated -as mentioned aboveby arthritis or enthesitis. Destructions of spine and joints reflect longer periods of persistent inflammation and result in different stages of functional deficits. This broad spectrum of signs and symptoms means a real challenge when combining individual and complex concepts of rehabilitation that is based on the sound knowledge of pathoanatomic evolution and its pathomechanical consequences. Diachronic damages arising during the protracted clinical course result in a synchronic presentation of actual findings. It is extremely important to evaluate the exact pre-rehabilitative functional status before a rehabilitation concept can be developed. This article tries to elucidate these interrelations, to integrate the various rehabilitation measures and to assess scientific evidence of effectiveness of different physiotherapeutic strategies curre...
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