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Juvenile idiopathische Arthritis-assoziierte Uveitis

Optimierung der immunmodulierenden Therapie

Uveitis associated with juvenile idiopathic arthritis

Optimization of immunomodulatory therapy

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Zusammenfassung

Hintergrund

Die juvenile idiopathische Arthritis (JIA)-assoziierte Uveitis ist eine visusgefährdende Erkrankung mit einer hohen Komplikationsrate. Neben einer Früherkennung durch Screeningprogramme ist eine adäquate Therapie essenziell, um die Langzeitprognose zu verbessern. Häufig ist eine Kortikosteroidtherapie nicht ausreichend. Neben konventionellen Immunsuppressiva bieten heute immunmodulierende Medikamente – sog. Biologika – neue Möglichkeiten zur Therapie.

Fragestellung

Es wird der Frage nachgegangen, welche Biologika für die Therapie der JIA-assoziierten Uveitis aktuell klinisch verwendet werden.

Material und Methode

Es erfolgen eine Literaturübersicht, Zusammenfassung von Therapieempfehlungen und eine Diskussion von Therapieoptionen für therapierefraktäre Patienten.

Ergebnisse

Entsprechend den aktuellen Therapieempfehlungen werden Tumornekrosefaktor (TNF)-Inhibitoren eingesetzt, wenn mit Kortikosteroiden und im nächsten Schritt mit konventionellen Immunsuppressiva (bevorzugt Methotrexat) keine Uveitisinaktivität erzielt werden kann. Nach aktueller Datenlage wird dann Adalimumab bevorzugt. Bei Wirkungsverlust unter Langzeittherapie und/oder Rezidiven stellen neuere Biologika interessante Therapieoptionen dar (z. B. Lymphozyteninhibitoren oder spezifische Rezeptorantagonisten).

Schlussfolgerungen

TNF-Inhibitoren haben einen wichtigen Stellenwert in der Therapie der JIA-assoziierten Uveitis. Erkenntnisse aus prospektiven Registern und Studien sind wünschenswert, um die Rolle von TNF-Inhibitoren und anderen Biologika vergleichend beurteilen zu können und die Therapieempfehlungen zu optimieren.

Abstract

Background

Uveitis associated with juvenile idiopathic arthritis (JIA-associated uveitis) is a vision-threatening disorder with a high complication rate. Besides early diagnosis within screening programs an adequate therapy is essential for improvement of the long-term prognosis. Corticosteroid therapy is often insufficient. In addition to conventional immunosuppression, immunomodulatory drugs, so-called biologicals, are novel highly effective treatment modalities.

Objective

A systematic search of the literature was carried out for biologicals currently used in the treatment of JIA-associated uveitis.

Material and methods

Review of current publications, summary of treatment guidelines and discussion of treatment options for therapy refractive patients.

Results

In accordance with the current recommendations tumor necrosis factor (TNF) inhibitors are administered if uveitis inactivity cannot be achieved with topical corticosteroids and in the next stage with immunosuppressants (methotrexate preferred). According to the currently available data adalimumab is then preferred. When the effectiveness of TNF inhibitors ceases during long-term administration and/or recurrences, other biological response modifiers are attractive treatment options (e. g. lymphocyte inhibitors or specific receptor antagonists).

Conclusion

The TNF inhibitors are of major importance for the treatment of JIA-associated uveitis. Prospective studies and registries would be desirable in order to be able to compare the value of TNF inhibitors and other biologicals and for optimization of treatment recommendations.

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Authors and Affiliations

  1. Augenabteilung, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland

    A. Heiligenhaus, K. Walscheid & C. Heinz

  2. Universitätsklinik für Augenheilkunde, Inselspital, Universität Bern, Bern, Schweiz

    C. Tappeiner

Authors
  1. A. Heiligenhaus
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  2. C. Tappeiner
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  3. K. Walscheid
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  4. C. Heinz
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Corresponding author

Correspondence to A. Heiligenhaus.

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Interessenkonflikt

C. Tappeiner und K. Walscheid geben an, dass kein Interessenkonflikt besteht. A. Heiligenhausweist auf folgende Beziehungen hin: Forschungsförderung von Pfizer und Novartis; klinische Studien AbbVie, Allergan, Alimera Sciences, pSivida, Santen, Servier, XOMA; Vortragstätigkeit: Bayer, Novartis. C. Heinz weist auf folgende Beziehungen hin: klinische Studien: Abbvie, Allergan, pSivida, Santen, Servier, XOMA; Vortragstätigkeit: Bayer, Novartis.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Heiligenhaus, A., Tappeiner, C., Walscheid, K. et al. Juvenile idiopathische Arthritis-assoziierte Uveitis. Ophthalmologe 113, 391–397 (2016). https://doi.org/10.1007/s00347-016-0262-4

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  • DOI: https://doi.org/10.1007/s00347-016-0262-4

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