Entzündliche Erkrankungen und Osteoporose – Potenzial der RANKL-Hemmung am Beispiel der Rheumatoiden Arthritis

Zusammenfassung

Die Rheumatoide Arthritis ist initial durch eine gelenknahe Osteoporose, im weiteren Verlauf durch eine zunehmende Gelenkdestruktion, aber auch durch eine der chronischen Entzündung geschuldete systemische Osteoporose charakterisiert. Beide Manifestationen werden wesentlich durch eine sowohl periartikulär als auch systemisch gesteigerte Osteoklastenaktivität verursacht. Verantwortlich hierfür ist eine relativ erhöhte Expression/Synthese von RANKL. Mit Denosumab, einem humanen RANKL-Antikörper, kann sowohl die knöcherne Gelenkdestruktion als auch die systemische Osteoporose aufgehalten werden. Denosumab vermag aber nicht die entzündliche Aktivität oder die damit verbundenen Schmerzen und funktionellen Einschränkungen zu beeinflussen.

Abstract

Rheumatoid arthritis is characterised by juxtaarticular osteoporosis in the early stage, and by increasing articular destruction in the further course, but also by systemic osteoporosis caused by chronic inflammation. These 2 manifestations are driven especially by increased activity of osteoclasts, both periarticular and systemic. The reason for this intensive osteoclast generation and functional activity is the high expression and synthesis of RANKL. With the application of denosumab, a fully human RANKL antibody, we are not only able to interrupt the articular destruction process but also to improve the bone mineral density. Denosumab, however, has no influence on inflammatory activity, pain and functional disability.

Schlüsselwörter

Rheumatoide Arthritis - Entzündung - Osteoporose - RANKL - Denosumab

Key words

rheumatoid arthritis - inflammation - osteoporosis - RANKL - denosumab

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