Magnetic resonance imaging allows early detection of inflammatory changes in the sacroiliac joints and spine. At an advanced stage, incipient ossification can also be visualized by conventional radiography. Sonography enables the clinician to evaluate the inflammation of the joints and tendon insertions.
Exercise and physical therapy appear particularly important for maintaining spinal mobility. A variety of nonsteroidal anti-inflammatory drugs are available as first-line medications. In cases of inadequate response and high disease activity, TNF and interleukin-17 inhibitors have become popular. These genetically engineered “biologics” inhibit the activity of individual inflammatory messenger substances such as TNF-alpha or interleukin-17, which play an important role in these diseases. Conventional basic therapeutics such as sulfasalazine, methotrexate or leflunomide are only used in cases involving the peripheral joints. In psoriatic arthritis, newer oral medications that specifically interfere with the immune system are also available: a phosphodiesterase inhibitor, as well as inhibitors of so-called Janus kinases (JAK inhibitors). Interleukin-23 inhibitors show an effect in psoriatic arthritis, but not on the inflammatory involvement of the spine in axial spondyloarthritis.
Our team cooperates in the field of spondyloarthritides within the Swiss Clinical Quality Management Program (SCQM) and on an international level with ASAS (Assessment of SpondyloArthritis international Society) and GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis).