臨床整形外科59巻4号

2024年04月発行

特集 脊椎関節炎SpAを理解する—疾患概念・診断基準・最新治療

脊椎関節炎の概念

著者： 山村昌弘¹

所属機関： ¹岡山済生会総合病院リウマチ・膠原病センター

ページ範囲：P.335 - P.340

脊椎関節炎(SpA)は付着部炎を共通する特徴とする慢性炎症性関節疾患群で，体軸性SpA(仙腸関節炎，脊椎炎)と末梢性SpA(関節滑膜炎，付着部炎，指趾炎)に大別される．体軸性SpAはX線基準を満たすものと満たさないもの(r-axSpA vs. nr-axSpA)に分類され，r-axSpAは強直性脊椎炎(AS)に相当する．末梢性SpAには乾癬性関節炎(PsA)，炎症性腸疾患に伴うSpA，反応性関節炎に加え，分類不能型SpA(uSpA)が含まれる．SpAの発症・病態にはMHCクラスI分子(HLA-B27など)が関与し，付着部に生ずる生体力学的ストレスによる組織損傷に対して過剰な免疫応答が誘導され，骨破壊と骨新生を伴う関節障害が進行する．病態にはIL-23/IL-17経路とTNF-α誘導が重要である．

参考文献

1) Rudwaleit M, Landewé R, van der Heijde D, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I):classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis 2009;68(6):770-6.

2) Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II):validation and final selection. Ann Rheum Dis 2009;68(6):777-83.

3) Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011;70(1):25-31.

4) McGonagle D, Aydin SZ, Gül A, et al. ‘MHC-I-opathy’-unified concept for spondyloarthritis and Behçet disease. Nat Rev Rheumatol 2015;11(12):731-40.

5) Gravallese EM, Schett G. Effects of the IL-23-IL-17 pathway on bone in spondyloarthritis. Nat Rev Rheumatol 2018;14(11):631-40.

6) Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol 2019;71(10):1599-613.

7) Gossec L, Baraliakos X, Kerschbaumer A, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies:2019 update. Ann Rheum Dis 2020;79(6):700-12.

8) Calin A, Porta J, Fries JF, et al. Clinical history as a screening test for ankylosing spondylitis. JAMA 1977;237(24):2613-4.

9) Rudwaleit M, Metter A, Listing J, et al. Inflammatory back pain in ankylosing spondylitis:a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum 2006;54(2):569-78.

10) Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook:a guide to assess spondyloarthritis. Ann Rheum Dis 2009;68 Suppl 2:ii1-44.

11) Sieper J, Poddubnyy D. Axial spondylitis. Lancet 2017;390(10089):73-84.

12) Stolwijk C, van Tubergen A, Castillo-Ortiz JD, et al. Prevalence of extra-articular manifestations in patients with ankylosing spondylitis:a systematic review and meta-analysis. Ann Rheum Dis 2015;74(1):65-73.

13) Feld J, Chandran V, Haroon N, et al. Axial disease in psoriatic arthritis and ankylosing spondylitis:a critical comparison. Nat Rev Rheumatol 2018;14(6):363-71.

14) van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984;27(4):361-8.

15) Lambert RG, Bakker PA, van der Heijde D, et al. Defining active sacroiliitis on MRI for classification of axial spondyloarthritis:update by the ASAS MRI working group. Ann Rheum Dis 2016;75(11):1958-63.

16) Rudwaleit M, Khan MA, Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis:do we need new criteria? Arthritis Rheum 2005;52(4):1000-8.

17) Boel A, Molto A, van der Heijde D, et al. Do patients with axial spondyloarthritis with radiographic sacroiliitis fulfil both the modified New York criteria and the ASAS axial spondyloarthritis criteria? Results from eight cohorts. Ann Rheum Dis 2019;78(11):1545-9.

18) Garg N, van den Bosch F, Deodhar A. The concept of spondyloarthritis:Where are we now? Best Pract Res Clin Rheumatol 2014;28(5):663-72.

19) Wang R, Gabriel SE, Ward MM. Progression of nonradiographic axial spondyloarthritis to ankylosing spondylitis:a population-based cohort study. Arthritis Rheumatol 2016;68(6):1415-21.

20) Protopopov M, Poddubnyy D. Radiographic progression in non-radiographic axial spondyloarthritis. Expert Rev Clin Immunol 2018;14(6):525-33.

21) Strand V, Rao SA, Shillington AC, et al. Prevalence of axial spondyloarthritis in United States rheumatology practices:Assessment of SpondyloArthritis International Society criteria versus rheumatology expert clinical diagnosis. Arthritis Care Res 2013;65(8):1299-306.

22) Matsubara Y, Nakamura Y, Tamura N, et al. A nationwide questionnaire survey on the prevalence of ankylosing spondylitis and non-radiographic axial spondyloarthritis in Japan. Mod Rheumatol 2022;32(5):960-7.

23) López-Medina C, Ramiro S, van der Heijde D, et al. Characteristics and burden of disease in patients with radiographic and non-radiographic axial Spondyloarthritis:a comparison by systematic literature review and meta-analysis. RMD Open 2019;5(2):e001108. doi:10.1136/rmdopen-2019-001108.

24) Deodhar A, Strand V, Kay J, et al. The term ‘non-radiographic axial spondyloarthritis’ is much more important to classify than to diagnose patients with axial spondyloarthritis. Ann Rheum Dis 2016;75(5):791-4.

25) Kameda H, Kobayashi S, Tamura N, et al. Non-radiographic axial spondyloarthritis. Mod Rheumatol 2021;31(2):277-82.