Medikamentöse Absetzstrategien in der Kinderrheumatologie

Zusammenfassung

Die Prognose der juvenilen idiopathischen Arthritis (JIA) hat sich durch die Anwendung neuer Therapiestrategien und moderner Antirheumatika erheblich verbessert. Viele Patienten erreichen heute eine langanhaltende Remission, was die Frage nach einem möglichen Absetzen der Therapie aufwirft. In der klinischen Praxis variiert das Vorgehen beim Absetzen von krankheitsmodifizierenden Antirheumatika erheblich. Dabei spielen Faktoren wie die spezifische Form der JIA, das initiale Therapieansprechen, das Vorhandensein von Krankheitsschäden sowie die Präferenzen von Patienten und Familien eine Rolle. Dieser Übersichtsbeitrag stellt die aktuelle Evidenz zur Therapiedeeskalation bei der JIA vor. Es werden relevante Studien und Prädiktoren für ein erfolgreiches Absetzen der Therapie diskutiert. Zudem werden Strategien zur Erreichung einer medikamentenfreien Remission erörtert, einschließlich der potenziellen Rolle von Biomarkern und bildgebenden Verfahren. Basierend auf den vorhandenen, wenngleich noch begrenzten, Erkenntnissen werden Hinweise für den klinischen Alltag formuliert.

Abstract

The prognosis for juvenile idiopathic arthritis (JIA) has improved significantly thanks to the use of new treatment strategies and modern anti-inflammatory drugs. Many patients now achieve long-term remission, which raises the question of whether treatment can be discontinued. In clinical practice, the approach to discontinuing disease-modifying anti-rheumatic drugs varies considerably. Factors such as the specific form of JIA, the initial response to therapy, the presence of disease damage, and the preferences of patients and families all play a role. This review article presents the current evidence on therapy de-escalation in JIA. Relevant studies and predictors for successful discontinuation of therapy are discussed. In addition, strategies for achieving drug-free remission are discussed, including the potential role of biomarkers and imaging techniques. Based on the available, albeit still limited, evidence, recommendations for everyday clinical practice are formulated.

Schlüsselwörter

juvenile idiopathische Arthritis - Therapiedeeskalation - Krankheitsschub - Disease-Modifying Antirheumatic Drugs - Remission

Keywords

juvenile idiopathic arthritis - therapy de-escalation - disease flare - disease-modifying antirheumatic drugs - remission

Publikationsverlauf

Artikel online veröffentlicht:
04. Dezember 2025

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