Innovative Therapie der juvenilen Spondylarthritis – Enthesitis-assoziierte Arthritis

Zusammenfassung

Juvenile Spondylarthritis steht für Erkrankungen, die u. a. die JIA-Kategorie der Enthesitisassoziierten Arthritis (EEA) und die juvenile ankylosiernde Spondylitis einschließen. Noch 10 Jahre zuvor bedeutete die Diagnose eine mitunter lebenslange Erkrankung mit Schmerzen und Behinderung. Nichtsteroidale Entzündungshemmer und Kortikosteroide waren die wesentlichen Säulen der Therapie. Sulfasalazin galt als das einzige Basistherapeutikum mit nachgewiesener Wirksamkeit, beschränkt auf periphere Manifestationen. Heute bestehen mit den Tumor-Nekrose-Faktor-Hemmern effektive, geprüft wirksame Behandlungsmöglichkeiten. Ein Wirksamkeitsnachweis gelang in 4 Doppelblindstudien: Infliximab bei der juvenilen Spondylarthritis, Adalimumab bei der juvenilen ankylosierenden Spondylitis und Adalimumab und Etanercept bei Patienten mit EAA. Zudem steht eine multinationale offene Studie mit historischen Placebokontrollen zum Wirksamkeitsnachweis mit Etanercept bei EAA zur Verfügung. Erreicht wurde die Zulassung von Adalimumab ab einem Alter von 6 Jahren und von Etanercept ab einem Alter von 12 Jahren, die nunmehr einen festen Platz im Therapiealgorithmus erlangt haben und eine realistische Chance auf eine rasche Remission der Erkrankung geben.

Summary

Juvenile spondylarthritis stands for diseases including the JIA category of enthesitis related arthritis (ERA) and juvenile ankylosing spondylitis. Only 10 years ago the diagnosis resulted into a sometimes life-long disease with pain and disability. Non-steroidal anti-inflammatories and corticosteroids were the main pillars of the therapy. Sulfasalazine was considered the only modifying antirheumatic with proven efficacy, however limited to peripheral manifestations. Today more effective, efficient, and tested treatment options are available with which remission of the disease comes in reach. For this purpose TNF-inhibitors are successful. A proof of concept was achieved with 4 double-blind controlled studies: infliximab for juvenile spondyarthritis, adalimumab for juvenile ankylosing spondylitis and adalimumab and etanercept in patients with ERA. In addition, there is a multinational open-label study with historical placebo control group for efficacy with etanercept. The approval of adalimumab and of etanercept from the age of 6 years and 12 years, respectively, has been achieved which both now found their place in the treatment algorithm and give a realistic chance to gain remission of the disease.

Schlüsselwörter

Juvenile idiopathische Arthritis - Enthesitis - Spondylarthritis - Etanercept - Adalimumab - Infliximab

Keywords

Juvenile idiopathic Arthritis - enthesitis - spondylarthritis - etanercept - adalimumab - infliximab

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