Abstract
Zusammenfassung. Bei chronisch entzündlichen Darmerkrankungen (Inflammatory Bowel Diseases, IBD) können nicht-entzündliche Gelenkschmerzen und entzündliche Gelenkmanifestationen auftreten. Letztere gehören zur Gruppe der Spondyloarthritiden. Sie werden am Achsenskelett als entzündlicher Rückenschmerz mit nächtlichen Schmerzen, Morgensteifigkeit und Besserung unter Aktivität manifest. Einschränkungen der Gelenkfunktion sind ebenfalls möglich. Bei anderen Patienten stehen periphere Gelenkbeschwerden im Vordergrund. Als Schmerzmedikamente werden COX-2-selektive, nicht-steroidale Antirheumatika (NSAR) empfohlen, da unselektive NSAR die zugrundeliegende IBD verschlimmern können. Am Achsenskelett werden Physiotherapie und Tumornekrosefaktor(TNF)-Inhibitoren eingesetzt, während bei peripherem Gelenkbefall Steroidinjektionen, Sulfasalazin und TNF-Inhibitoren wirksam sind. Entzündung, Malabsorption und Steroide führen bei IBD-Patienten zu Osteopenie und Osteoporose. Bei langdauernder Krankheitsaktivität bzw. langer Steroidgabe ist ein Screening mit DXA-Scan indiziert. Therapeutisch sollten ausreichend Kalzium und Vitamin D sowie gegebenenfalls Bisphosphonate gegeben werden.
Abstract. Inflammatory bowel diseases (IBD) are frequently accompanied by non-inflammatory joint pain and inflammatory spondyloarthritides. Spondyloarthritides can restrict joint function and typically manifest with inflammatory back pain with nightly pain and morning stiffness that improves upon exercising. In other patients, small or large peripheral joints are predominantly involved. Treatment comprises pain medication including COX-II selective non-steroidal anti-inflammatory drugs (NSAID), since non-selective NSAID can aggravate IBD. For axial manifestations, physiotherapy and tumor necrosis factor (TNF) inhibitors are effective, while for peripheral manifestations steroid injections, sulfasalazine and TNF inhibitors are useful. Osteopenia and osteoporosis may result from inflammation, malabsorption and/or steroids. Long-lasting disease activity or steroid treatment should prompt osteoporosis screening. Adequate calcium and vitamin D intake must be ensured and treatment with bisphosphonates evaluated.
Résumé. Les maladies inflammatoires intestinales chroniques peuvent être associées à des arthralgies non inflammatoires et inflammatoires, ces dernières appartenant aux en miniscule spondylarthropathies. L’atteinte axiale comprend des dorsalgies nocturnes et une raideur matinale améliorée par le mouvement. Chez certains patients, les arthropathies périphériques prédominent. Les anti-inflammatoires non stéroïdiens COX-II sélectifs sont la base du traitement. L’atteinte axiale est traitée efficacement par la physiothérapie et les anti-TNF, alors que les atteintes périphériques sont traitées par la en miniscule sulfasalazine, les injections de stéroïdes ou les anti-TNF. L’inflammation, la malabsorption et les stéroïdes précipitent une ostéopénie/ostéoporose. La densitométrie osseuse est indiquée en cas d’inflammation prolongée ou de prise de stéroïdes. Un apport suffisant de calcium et vitamine D est essentiel. Un traitement par biphosphonates est parfois nécessaire.
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