Neues aus der Kinder-Rheumatologie

Hartmut Michels; Renate Häfner

doi:10.1055/s-0037-1618501

Arthritis und Rheuma, Table of Contents

Arthritis und Rheuma 2005; 25(03): 141-148
DOI: 10.1055/s-0037-1618501

Innovationen auf dem Prüfstand

Schattauer GmbH

Neues aus der Kinder-Rheumatologie

Recent developments in pediatric rheumatology

Authors

Hartmut Michels

¹Deutsches Zentrum für Kinder- und Jugendrheumatologie Garmisch-Partenkirchen (Ärztlicher Direktor: Dr. H. Michels)
Renate Häfner

¹Deutsches Zentrum für Kinder- und Jugendrheumatologie Garmisch-Partenkirchen (Ärztlicher Direktor: Dr. H. Michels)

Abstract

Zusammenfassung

Bemerkenswerte Fortschritte in der Kinder- und Jugendrheumatologie haben während der letzten 15 Jahre zu einer Verbesserung der Langzeitprognose der juvenilen idiopathischen Arthritis (JIA) geführt. Bei den chronischen Arthritiden setzt sich zunehmend die JIA-Klassifikation durch. Für Studien wurden Verbesserungskriterien entwickelt, die eine Entscheidung darüber ermöglichen, ob im Verlauf eine Verbesserung erzielt wurde oder nicht. Diagnostisch hat die Identifizierung der genetischen Defekte bei periodischen Fiebersyndromen wie Muckle-Wells-Syndrom eine klare Abgrenzung zur systemischen JIA (sJIA) ermöglicht. Basistherapeutisch stellt Methotrexat (MTX) bei der JIA nach wie vor den „Goldstandard“ dar. Im Rahmen einer multizentrischen, internationalen Studie konnte jedoch gezeigt werden, dass bei unzureichender Effektivität eine Do-siserhöhung über 15 mg MTX/m² KOF/Woche keinen zusätzlichen Gewinn bringt. In solchen Fällen kann Etanercept erwogen werden, das allerdings bei sJIA häufig unwirksam ist.

Von den bildgebenden Verfahren hat die Sonographie in der Kinderrheumatologie wegen der fehlenden Strahlenbelastung und beliebigen Wiederholbarkeit eine Sonderstel-lung inne. Das Röntgenbild hat in der Verlaufsbeobachtung der JIA nach wie vor Bedeutung und ist wie auch die Kernspintomographie darüber hinaus für die Differenzialdiagnostik wichtig.

Summary

Remarkable advances in pediatric rheumatology have improved long term prognosis of juvenile idiopathic arthritis (JIA) during the last 15 years. The ILAR classification for JIA is increasingly accepted for chronic arthritis. Core sets of improvement have been developed, which enable decision whether or not the patient has improved during course. Concerning diagnosis, the identification of genetic defects in periodic fever syndromes like the Muckle-Wells-Syndrome, allow a clear differentiation to systemic JIA (sJIA). Methotrexate (MTX) remains “gold standard” as a disease modifying drug for JIA. An international multicenter study, however, showed that insufficient efficacy of the drug cannot be improved by increasing the dosage over 15 mg MTX/ m ²/week. For those cases Etanercept can be considered, which however is often ineffective in sJIA. Among the imaging procedures sonography holds an exceptional position due to its missing radial exposition and the possibility to frequently repeat the examination. Radiography is still important for follow-up of JIA and together with magnetic resonance imaging plays a dominant role for differential diagnosis.

Schlüsselwörter

Juvenile idiopathische Arthritis - Klassifikation - Diagnostik - Therapie

Keywords

Juvenile idiopathic arthritis - classification - diagnosis - treatment

Full Text

References

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