Arthritis und Rheuma 2021; 41(01): 47-52
DOI: 10.1055/a-1341-6971
Kinderrheumatologie
Übersichtsartikel

Gelenksonografie im Treat-to-Target-Konzept bei der juvenilen idiopathischen Arthritis

Musculoskeletal ultrasound in the treat-to-target management of juvenile idiopathic arthritis
Faekah Gohar
1   Klinik für Kinder- und Jugendrheumatologie, St. Josef-Stift Sendenhorst
,
Daniel Windschall
1   Klinik für Kinder- und Jugendrheumatologie, St. Josef-Stift Sendenhorst
› Author Affiliations

ZUSAMMENFASSUNG

In unserem Artikel werden aktuelle Bedeutung und Entwicklung der Gelenksonografie als fester Bestandteil eines „Treat-to-Target“-Konzeptes bei der Behandlung der juvenilen idiopathischen Arthritis (JIA) dargestellt und diskutiert. Dabei nimmt die Gelenksonografie neben der klinischen Untersuchung eine entscheidende Rolle in der frühen Diagnosestellung einer JIA ein mit dem Ziel, dem Patienten so früh wie möglich eine effiziente Therapie zukommen zu lassen (Window of Opportunity). Zusätzlich kann die Gelenksonografie, eingebettet in das „Treat-to-Target“-Konzept, eine wichtige Rolle in der Verlaufskontrolle und Evaluation einer subklinischen Entzündungsaktivität spielen. Bisherige etablierte Diagnose-, Verlaufs- und auch Remissionskriterien einer JIA lassen stringente und objektivierbare bildgebende Kriterien vermissen, obwohl sich Qualität und Erfahrung bei der Gelenksonografie stetig verbessern. Neben den sonografischen Kriterien haben sich inzwischen auch verschiedene Biomarker zur Beurteilung der Krankheitsaktivität etabliert. Mit der Entwicklung der Sonografie und sicheren Testung von Biomarkern könnte sich in Zukunft zur frühen Diagnosestellung und sicheren Remissionseinschätzung eine Kombination aus immunologischen und sonografischen Kriterien etablieren, die das bisherige „Treat-to-Target“-Konzept bei der JIA unterstützen und verbessern.

SUMMARY

In this article the current role and development of musculoskeletal ultrasound as a central component of treat-to-target management of JIA is discussed. Musculoskeletal ultrasound alongside clinical examination plays a significant role in the early diagnosis of JIA, with the aim of initiating treatment as soon as possible and within the “window of opportunity”. Including ultrasound in treat-to-target strategies could play an important role in the monitoring and evaluation of clinical as well as subclinical inflammation. However, despite continuous improvements in the quality and experience of ultrasound capabilities, existing diagnostic, prognostic and remission criteria are still lacking objective imaging-specific criteria. Other than ultrasound, immunological biomarkers have also shown utility for the evaluation of clinical activity. The development of ultrasound and routine testing of biomarkers, and potentially both combined, could allow earlier diagnosis and more accurate prediction of disease remission, thereby supporting and improving the ability to treat JIA to target.



Publication History

Article published online:
26 February 2021

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