Arthritis und Rheuma 2017; 37(06): 411-417
DOI: 10.1055/s-0038-1624231
Übersichtsartikel
Schattauer GmbH

Die juvenile Psoriasis-Arthritis

Klassifikation, Klinik, Pathogenese und TherapieJuvenile psoriasis arthritisClassification, symptoms, pathogenesis and treatment
N. Brüggemann
1   Deutsches Rheuma-Forschungszentrum Berlin
,
K. Minden
1   Deutsches Rheuma-Forschungszentrum Berlin
,
C. Sengler
1   Deutsches Rheuma-Forschungszentrum Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
10 January 2018 (online)

Zusammenfassung

Die juvenile Psoriasis-Arthritis (jPsA), eine Subgruppe der juvenilen idiopathischen Arthritis, stellt kein einheitliches Krankheitsbild dar. Dies führt bis heute zu Schwierigkeiten bei der Klassifikation. Es sind zumindest zwei Gruppen von Patienten zu unterscheiden: i)die im Kleinkind-/Vorschulalter erkrankten, meist weiblichen, häufig ANA-positiven Patienten, die oft eine Daktylitis und/oder einen Befall kleiner Gelenke zeigen, sowie ii)jene, die im Schulalter erkranken, häufiger eine Enthesitis und/oder einen axialen Gelenkbefall aufweisen und sich damit eher wie eine Spondyloarthritis bzw. PsA des Erwachsenen präsentieren. Pathophysiologisch fand man eine Dysbalance von regulatorischen und proinflammatorischen Immunzellen und deren jeweiligen Mediatoren, hier insbesondere von dendritischen Zellen und T-Zellen mit der Produktion von IL-23, IL-17 und TNF-alpha. Aus diesen Erkenntnissen konnten neue Therapien, die spezifisch diese Mechanismen blockieren, entwickelt werden, von denen bisher allerdings nur ein TNFalpha-Blocker für die jPsA zugelassen ist. Bei gleichzeitigem Befall von Haut und Gelenken können die Patienten gegebenenfalls von der Zulassung neuer Substanzen für die Hautmanifestation profitieren.

Summary

Juvenile psoriasis arthritis (jPsA), a subgroup of juvenile idiopathic arthritis, does not represent a uniform clinical entity. This has led to difficulties in the classification until today. At least two groups of patients are to be distinguished – patients with disease onset in infantile/pre-school age, who are mostly female, often ANA-positive and present with dactylitis and/or involvement of small joints, and patients with symptom onset in school age, who are more likely to have enthesitis and axial joint involvement and thus resemble more patients with spondyloarthritis or adult-onset PsA. Pathophysiologically, a dysbalance of regulatory and proinflammatory immune cells and their respective mediators was found, in particular dendritic cells and T-cells with the production of IL-23, IL-17 and TNF-alpha. Based on these findings, new therapies that specifically block these mechanisms have been developed, of which only one TNF-alpha-blocker has been approved for juvenile PsA so far. Patients with simultaneous infestation of skin and joints may benefit from the approval of new substances for skin manifestation.

 
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