Zusammenfassung
Die physiologischen Altersveränderungen wie Verlust von Muskelmasse und -funktion, Reduzierung von Organfunktionen und degenerative Gelenkveränderungen treffen bei Patienten mit ankylosierender Spondylitis (AS) auf krankheitsspezifische Veränderungen, die ältere AS-Patienten vulnerabel für andere Erkrankungen machen. Verschiedene Prozesse führen bei solchen Patienten zu einer reduzierten körperlichen Funktionsfähigkeit, zu einer veränderten Körperhaltung, zu verminderter Knochendichte und Sarkopenie, was zu vermehrter Fallneigung und Wirbelkörperfrakturen führen kann. Die Mortalität ist bei Patienten mit AS v. a. bei Männern insbesondere aufgrund der erhöhten kardiovaskulären Mortalität erhöht. Die standardisierte Erfassung kardiovaskulärer Risikofaktoren bei Patienten mit entzündlich rheumatischen Erkrankungen wird zwar seit Jahren empfohlen (unabhängig vom Alter der Patienten), dies wird jedoch kaum umgesetzt. Insgesamt liegen hinsichtlich Komorbiditäten und Risikofaktoren fast ausschließlich Untersuchungen bei AS-Patienten und nicht anderen Spondyloarthritiden vor.
Abstract
The combination of physiological age-related changes (e. g. reduction in muscle mass and function, reduction in organ function and degenerative changes in joints) and disease-specific changes of ankylosing spondylitis (AS), make older AS patients vulnerable for additional diseases. In this patient population various processes lead to a reduction in physical function, changes in posture, osteoporosis and sarcopenia, which then can result in falls and fractures, especially vertebral fractures. Mortality is increased in patients with AS, particularly in men due to an increase in cardiovascular mortality. Although the standardized assessment of cardiovascular risk factors in patients with inflammatory rheumatic diseases (independent of age) has been recommended for years, it is rarely done in clinical practice. Overall, data on comorbidities and risk factors are only available for AS patients and are lacking for other forms of spondyloarthritides.
Literatur
Sieper J, Poddubnyy D (2017) Axial spondyloarthritis. Lancet. https://doi.org/10.1016/S0140-6736(16)31591-4
Appel H, Janssen L, Listing J, Heydrich R, Rudwaleit M, Sieper J (2008) Serum levels of biomarkers of bone and cartilage destruction and new bone formation in different cohorts of patients with axial spondyloarthritis with and without tumor necrosis factor-alpha blocker treatment. Arthritis Res Ther 10(5):R125
Klingberg E, Lorentzon M, Mellstrom D, Geijer M, Gothlin J, Hilme E et al (2012) Osteoporosis in ankylosing spondylitis—prevalence, risk factors and methods of assessment. Arthritis Res Ther 14(3):R108
Nurmohamed MT, van der Horst-Bruinsma I, Maksymowych WP (2012) Cardiovascular and cerebrovascular diseases in ankylosing spondylitis: current insights. Curr Rheumatol Rep 14(5):415–421
Bakland G, Gran JT, Nossent JC (2011) Increased mortality in ankylosing spondylitis is related to disease activity. Ann Rheum Dis 70(11):1921–1925
Exarchou S, Lie E, Lindstrom U, Askling J, Forsblad-d’Elia H, Turesson C et al (2016) Mortality in ankylosing spondylitis: results from a nationwide population-based study. Ann Rheum Dis 75(8):1466. https://doi.org/10.1136/annrheumdis-2015-207688
Vosse D, Landewe R, van der Heijde D, van der Linden S, van Staa TP, Geusens P (2009) Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis 68(12):1839–1842
Briot K, Etcheto A, Miceli-Richard C, Dougados M, Roux C (2016) Bone loss in patients with early inflammatory back pain suggestive of spondyloarthritis: results from the prospective DESIR cohort. Rheumatology (Oxford) 55(2):335–342
Mitra D, Elvins DM, Speden DJ, Collins AJ (2000) The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology (Oxford) 39(1):85–89
Davey-Ranasinghe N, Deodhar A (2013) Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 25(4):509–516
Briot K, Roux C, Gossec L, Charni N, Kolta S, Dougados M et al (2008) Effects of etanercept on serum biochemical markers of cartilage metabolism in patients with spondyloarthropathy. J Rheumatol 35(2):310–314
Durnez A, Paternotte S, Fechtenbaum J, Landewe RB, Dougados M, Roux C et al (2013) Increase in bone density in patients with spondyloarthritis during anti-tumor necrosis factor therapy: 6‑year followup study. J Rheumatol 40(10):1712–1718
Allali F, Breban M, Porcher R, Maillefert JF, Dougados M, Roux C (2003) Increase in bone mineral density of patients with spondyloarthropathy treated with anti-tumour necrosis factor alpha. Ann Rheum Dis 62(4):347–349
van der Weijden MA, van Denderen JC, Lems WF, Nurmohamed MT, Dijkmans BA, van der Horst-Bruinsma IE (2016) Etanercept increases bone mineral density in ankylosing spondylitis, but does not prevent vertebral fractures: results of a Prospective Observational Cohort Study. J Rheumatol 43(4):758–764
Kiltz U, Oberschelp U, Schneider E, Swoboda B, Bohm H, Winking M et al (2014) German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew’s disease and early forms: 8.6 Invasive therapy. Z Rheumatol 73(Suppl 2):97–100
Westerveld LA, Verlaan JJ, Oner FC (2009) Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J 18(2):145–156
Pray C, Feroz NI, Nigil Haroon N (2017) Bone mineral density and fracture risk in ankylosing spondylitis: a meta-analysis. Calcif Tissue Int 101(2):182–192
Geusens P, De Winter L, Quaden D, Vanhoof J, Vosse D, van den Bergh J et al (2015) The prevalence of vertebral fractures in spondyloarthritis: relation to disease characteristics, bone mineral density, syndesmophytes and history of back pain and trauma. Arthritis Res Ther 17:294
Maas F, Spoorenberg A, van der Slik BP, van der Veer E, Brouwer E, Bootsma H et al (2017) Clinical risk factors for the presence and development of vertebral fractures in patients with ankylosing spondylitis. Arthritis Care Res 69(5):694. https://doi.org/10.1002/acr.22980
van der Heijde D, Ramiro S, Landewe R, Baraliakos X, Van den Bosch F, Sepriano A et al (2017) 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 76(6):978–991
Kiltz U, Rudwaleit M, Sieper J, Krause D, Chenot JF, Stallmach A et al (2014) German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew’s disease and early forms: 3 Clinical symptoms. Z Rheumatol 73(Suppl 2):28–39
Murray HC, Elliott C, Barton SE, Murray A (2000) Do patients with ankylosing spondylitis have poorer balance than normal subjects? Rheumatology (Oxford) 39(5):497–500
Vergara ME, O’Shea FD, Inman RD, Gage WH (2012) Postural control is altered in patients with ankylosing spondylitis. Clin Biomech 27(4):334–340
Briot K, Garnero P, Le Henanff A, Dougados M, Roux C (2005) Body weight, body composition, and bone turnover changes in patients with spondyloarthropathy receiving anti-tumour necrosis factor {alpha} treatment. Ann Rheum Dis 64(8):1137–1140
Plasqui G, Boonen A, Geusens P, Kroot EJ, Starmans M, van der Linden S (2012) Physical activity and body composition in patients with ankylosing spondylitis. Arthritis Care Res (Hoboken) 64(1):101–107
El Maghraoui A, Ebo’o FB, Sadni S, Majjad A, Hamza T, Mounach A (2016) Is there a relation between pre-sarcopenia, sarcopenia, cachexia and osteoporosis in patients with ankylosing spondylitis? BMC Musculoskelet Disord 17:268
Edwards MH, Buehring B (2015) Novel approaches to the diagnosis of sarcopenia. J Clin Densitom 18(4):472–477
Giles JT, Ling SM, Ferrucci L, Bartlett SJ, Andersen RE, Towns M et al (2008) Abnormal body composition phenotypes in older rheumatoid arthritis patients: association with disease characteristics and pharmacotherapies. Arthritis Rheum 59(6):807–815
Fuggle N, Shaw S, Dennison E, Cooper C (2017) Sarcopenia. Best Pract Res Clin Rheumatol 31(2):218–242
Cesari M, Nobili A, Vitale G (2016) Frailty and sarcopenia: from theory to clinical implementation and public health relevance. Eur J Intern Med 35:1–9
Morley JE (2016) Pharmacologic options for the treatment of sarcopenia. Calcif Tissue Int 98(4):319–333
Schoene D, Kiesswetter E, Sieber CC, Freiberger E (2017) Musculoskeletal factors, sarcopenia and falls in old age. Z Gerontol Geriatr. https://doi.org/10.1007/s00391-017-1283-6. [Epub ahead of print]
Dursun N, Sarkaya S, Ozdolap S, Dursun E, Zateri C, Altan L et al (2015) Risk of falls in patients with ankylosing spondylitis. J Clin Rheumatol 21(2):76–80
Eriksson JK, Jacobsson L, Bengtsson K, Askling J (2017) Is ankylosing spondylitis a risk factor for cardiovascular disease, and how do these risks compare with those in rheumatoid arthritis? Ann Rheum Dis 76(2):364. https://doi.org/10.1136/annrheumdis-2016-209315
Bengtsson K, Forsblad-d’Elia H, Lie E, Klingberg E, Dehlin M, Exarchou S et al (2017) Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. Arthritis Res Ther 19(1):102
Bremander A, Petersson IF, Bergman S, Englund M (2011) Population-based estimates of common comorbidities and cardiovascular disease in ankylosing spondylitis. Arthritis Care Res (Hoboken) 63(4):550–556
Peters MJ, van Eijk IC, Smulders YM, Serne E, Dijkmans BA, van der Horst-Bruinsma IE et al (2010) Signs of accelerated preclinical atherosclerosis in patients with ankylosing spondylitis. J Rheumatol 37(1):161–166
Mathieu S, Gossec L, Dougados M, Soubrier M (2011) Cardiovascular profile in ankylosing spondylitis: a systematic review and meta-analysis. Arthritis Care Res (Hoboken) 63(4):557–563
Mathieu S, Pereira B, Soubrier M (2015) Cardiovascular events in ankylosing spondylitis: an updated meta-analysis. Semin Arthritis Rheum 44(5):551–555
Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ et al (2017) EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 76(1):17–28
Coxib and traditional NSAID Trialists’ (CNT), Bhala N, Emberson J, Merhi A, Abramson S et al (2013) Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 382(9894):769–779
Burmester G, Lanas A, Biasucci L, Hermann M, Lohmander S, Olivieri I et al (2011) The appropriate use of non-steroidal anti-inflammatory drugs in rheumatic disease: opinions of a multidisciplinary European expert panel. Ann Rheum Dis 70(5):818–822
Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J et al (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 64(4):465–474
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
U. Kiltz, X. Baraliakos, B. Buehring und J. Braun geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
Additional information
Redaktion
E. Märker-Hermann, Wiesbaden
H.-J. Lakomek, Minden
Rights and permissions
About this article
Cite this article
Kiltz, U., Baraliakos, X., Buehring, B. et al. Älter werden mit axialer Spondyloarthritis. Z Rheumatol 77, 363–368 (2018). https://doi.org/10.1007/s00393-018-0446-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00393-018-0446-1