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Therapie der Psoriasisarthritis

Gibt es eine Differenzialindikation?

Treatment of psoriatic arthritis

Are there differential indications?

Zusammenfassung

Die Psoriasisarthritis (PsA) ist eine sehr heterogene Erkrankung, die neben der Beteiligung der Haut und der Gelenke auch enthesiale, axiale und extramuskuloskeletale Manifestationsformen aufweisen und darüber hinaus mit weiteren, assoziierten Erkrankungen verbunden sein kann. Daher erfolgt die individualisierte Auswahl einer effektiven und patientenorientierten Therapie zum einen unter Berücksichtigung der Ausprägungen unterschiedlicher Manifestationen der PsA selbst, aber eben auch von weiteren einflussnehmenden Faktoren. Verschiedene Empfehlungen zur Auswahl und Steuerung der geeigneten Therapie stehen dem Behandler zur Verfügung. Hierbei finden die Empfehlungen der European League Against Rheumatism (EULAR) und die der Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) national und international in der Routine Anwendung. Beide Empfehlungen stehen seit 2016 in einer aktualisierten Version zur Verfügung. Spezielle deutsche Therapieempfehlungen fehlen derzeit. Entsprechend der in der Therapie der rheumatoiden Arthritis etablierten Treat-to-Target-Strategie, sollte es auch das Ziel der PsA-Behandlung sein, im Idealfall eine Remission oder zumindest eine minimale Krankheitsaktivität, eine sog. „minimal disease activity“ (MDA), zu erreichen. Gerade neue Therapieoptionen, die gezielt unterschiedliche Targets adressieren, bieten Möglichkeiten einer immer differenzierteren medikamentösen Behandlung zur Verbesserung der Versorgung der PsA-Patienten v. a. mit Fokus auf personalisierte Strategien zur optimalen Behandlung verschiedener Manifestationsformen und -muster.

Abstract

Psoriatic arthritis (PsA) is a very heterogeneous immune-mediated disease that usually involves skin and joints but can also affect entheses and extra-articular structures during the disease course. Furthermore, it can also be linked with other associated diseases. Therefore, the individualized selection of an effective and patient-oriented treatment must be carried out taking the extent of various manifestations of the PsA itself and also of other influencing factors into consideration. Various recommendations for selection and control of the suitable treatment of PsA are available for clinical use. The recommendations of the European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) are the two recommendations that are frequently used and internationally acknowledged. Both recommendations were updated in 2016. Specific German treatment recommendations are currently missing. In analogy to the treat-to-target strategy for rheumatoid arthritis, at least minimal disease activity (MDA) should be achieved in PsA patients with the use of specific therapeutic interventions if remission as the maximum therapeutic goal cannot be reached. New treatment options, which target different specific molecules, offer possibilities for a more differentiated personalized medicinal treatment for improvement of the care of PsA patients. This particularly applies to a focus on personalized strategies for optimal treatment of various manifestation forms and patterns.

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Correspondence to Dr. F. Behrens.

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Interessenkonflikt

Die Autoren geben folgende Interessenkonflikte an: M. Köhm: Forschungsunterstützung von Janssen, Pfizer, AbbVie; Vortrags‑/Beraterhonorar: Janssen, Pfizer, Celgene. F. Behrens: Forschungsunterstützung: AbbVie, Pfizer, Roche, Chugai, Novartis; Vortrags‑/Beraterhonorar: AbbVie, Pfizer, Roche, Chugai, UCB, BMS, Celgene, MSD, Novartis, Biotest, Janssen, Genzyme, Lilly, Sandoz.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Köhm, M., Behrens, F. Therapie der Psoriasisarthritis. Z Rheumatol 79, 23–32 (2020). https://doi.org/10.1007/s00393-019-00709-x

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Schlüsselwörter

  • Treat-to-Target
  • Minimal disease activity
  • Therapieempfehlungen
  • European League Against Rheumatism
  • Group for Research and Assessment of Psoriasis and Psoriatic Arthritis

Keywords

  • Treat-to-target
  • Minimal disease activity
  • Treatment recommendations
  • European League Against Rheumatism
  • Group for Research and Assessment of Psoriasis and Psoriatic Arthritis