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Kinder- und Jugendmedizin 2006; 6(05): 283-292
DOI: 10.1055/s-0037-1617918
Kinderrheumatologie
Schattauer GmbH

Aktuelle Therapie der juvenilen idiopathischen Arthritis mit Biologika

Biologic agents for treatment of juvenile idiopathic arthritis
Gerd Horneff
1   Zentrum für Kinder- und Jugendmedizin an der Asklepios Klinik Sankt Augustin (Leitung: Prof. Dr. med. Gerd Horneff)
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Publication History

Publication Date:
11 January 2018 (online)

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Zusammenfassung

Die juvenile idiopathische Arthritis (JIA) ist eine heterogene Gruppe von Erkrankungen mit den gemeinsamen Merkmalen einer chronischen Arthritis unklarer Ätiologie und dem Auftreten im Kindesalter. Die Prognose wird zum Teil von der Anzahl betroffener Gelenke und vom Auftreten extraartikulärer Manifestationen, z. B. einer chronischen Uveitis, bestimmt. Destruierende Verläufe sind bei Vorliegen einer Polyarthritis insbesondere bei systemischem Beginn häufig. Neue Therapiestrategien unter Einsatz von Biologika, einer Gruppe von gentechnologisch produzierten hoch spezifischen antientzündlichen Substanzen, erwiesen sich auch bei zuvor therapieresistenten Patienten als wirksam. Neben den drei Antagonisten des Tumor-Nekrose-Faktors (Etanercept, Adalimumab und Infliximab) stehen Inhibitoren weitere Zytokine, Anakinra, ein IL-1-Reptorantagonist und Tocilizumab, ein Antikörper gegen den Interleukin-6-Rezeptor sowie gegen zellständige Membranproteine gerichtete Antikörper, wie z. B. der CD20-Antikörper Rituximab und das Fusionsprotein Abatacept, gegen ein kostimulatorisches Membranantigen zur Verfügung.

Die Aufgabe dieser Übersicht ist die Darstellung der therapeutischen Optionen mit dem aktuellen Repertoire an Biologika, das den differenziellen Einsatz zur Behandlung der juvenilen idiopathischen Arthritis bei Polyarthritis, bei systemischem Verlauf und bei der Uveitis ermöglicht.

Summary

The term juvenile idiopathic arthritis (JIA) stands for a group of heterogeneous chronic inflammatory diseases with uncertain outcome especially in patients with systemic onset and polyarticular course. Patients may suffer from severe joint damage leading to mutilations as well as from extraarticular manifestations including chronic uveitis.

Biologics, highly specific genetically derived biodrugs with anti-inflammatory potential, have been shown to be very effective including those patients who have been unresponsive to prior therapy.

Besides the three Tumour-Necrosis-Factor antagonists (Etanercept, Adalimumab and Infliximab) actually there were further inhibitors of proinflammatory cytokines, Anakinra, an interleukin-1 receptor antagonist and Tocilizumab, an antibody direct towards the interleukin-6 receptor as well as antibodies directed to membrane bound proteins like the anti-CD20 antibody Rituximab and Abatacept, an immunoglobulin CTLA4 fusion protein able to block costimulatory signals.

The aim of this report is to introduce the current therapeutic options of blocking proinflammatory signals and pathways using the actually available repertoire of biologics, possibly leading to a preferential use of single biologics for treatment of in polyarthritis versus systemic arthritis or uveitis.

Schlüsselwörter

Juvenile idiopathische Arthritis - Biologika

Keywords

Juvenile arthritis - biologics
 

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